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B Meyboom-de Jong

Publications and source records attributed to B Meyboom-de Jong.

At least 19 recordsLinked to original sources
PubMed2005

[Use of stairs in a hospital increased by a sign near the stairs or the elevator].

OBJECTIVE: To investigate whether signs encouraging taking the stairs or discouraging taking the elevator lead to an increasing number of patients taking the stairs instead of the elevator in a hospital. DESIGN: Interventional study. METHOD: During a period of 6 weeks in the period October-December 2004, an investigator recorded how many patients took the stairs and how many took the elevator on the first floor of a hospital close to a diabetes outpatient clinic. A baseline measurement was done over a period of 2 weeks and 4 weeks were used for evaluating the effect of 2 different interventions, each lasting 2 weeks. During the first intervention, a sign was hung up near the elevator, which read: 'Exercise is healthy, take the stairs'. During the second intervention the sign read: 'Use of this elevator is exclusively for personnel and persons with restricted mobility'. Staff members and disabled patients were excluded from the study. RESULTS: A total of 2674 movements were counted. Use of the stairs increased statistically significantly during both interventions: from 54.6% to 63.4% during the first intervention and to 70.4% during the second intervention. CONCLUSION: Signs in a diabetes outpatient clinic that either encouraged the use of the stairs or discouraged the use of the elevator increased the patients' use of the stairs.

Elevators and Escalators↗
PubMed2005

Pitfalls in blood pressure measurement in daily practice.

BACKGROUND: Accurate blood pressure (BP) readings and correctly interpreting the obtained values are of great importance. However, there is considerable variation in the different BP measuring methods suggested in guidelines and used in hypertension trials. OBJECTIVE: To compare the different methods used to measure BP; measuring once, the method used for a large study such as the UKPDS, and the methods recommended by various BP guidelines. METHODS: In 223 patients with type 2 diabetes from five family practices BP was measured according to a protocol to obtain the following data: A = first reading, B = mean of two initial readings, C = at least four readings and the mean of the last three readings with less than 15% coefficient of variation difference, D = mean of the first two consecutive readings with a maximum of 5 mm Hg difference. Mean outcomes measure is the mean difference between different BP measuring methods in mm Hg. RESULTS: Significant differences in systolic/diastolic BP were found between A and B [mean difference (MD) systolic BP 1.6 mm Hg, P < 0.001], B and C (MD 5.7/2.8 mm Hg, P < 0.001), B and D (MD 6.2/2.8 mm Hg, P < 0.001), A and C (MD 7.3/3.3 mm Hg), and A and D (MD 7.9/3.0 mm Hg, P < 0.001). CONCLUSION: Different methods to assess BP during one visit in the same patient lead to significantly different BP readings and can lead to overestimation of the mean BP. These differences are clinically relevant and show a gap between different methods in trials, guidelines and daily practice.

Adult↗
PubMed2005

[Cause of death: from primary disease to direct cause of death].

Following the death of a patient, the treating physician in the Netherlands is required to fill out two forms. Form A, which is the certificate of death and Form B, which is used by the Statistics Netherlands to compile data on causes ofdeath. The latter form often poses difficulty for the physician with respect to the primary cause of death. This applies particularly to cases of sudden death, which account for one third of all deaths in the Netherlands. As a result, the statistical analyses appear to lead to an incorrect representation of the distribution of causes of death. A more thorough investigation into the primary cause of death is desirable, if necessary, supported by a request for an autopsy. The primary cause of death is to be regarded as the basic disease from which the cascade of changes ultimately leading to death originated.

Autopsy↗
PubMed2005

[Changes in the medical curriculum in Mongolia].

Since 1996, general practitioners from the universities in Amsterdam, Groningen and Leeds (England) have been involved in restructuring the medical curriculum in Mongolia. The Mongolians desired a problem-based and integrated new curriculum that would be suitable for training generalists. We started by training Mongolian teachers in modern pedagogic developments and in multidisciplinary consultation. The new curriculum started in 1999 and after a cumbersome start, integration was achieved, the library was completely renewed and equipped for self-study and rural opportunities were created so that medical students could acquire practical experience outside of the university hospital. The new curriculum is a step in the direction of training doctors who will be able to function independently in the new Mongolian health-care system.

Adult↗
PubMed2005

Shared care with task delegation to nurses for type 2 diabetes: prospective observational study.

BACKGROUND: To study the effects of two different structured shared care interventions, tailored to local needs and resources, in an unselected patient population with type 2 diabetes mellitus. METHODS: A three-year prospective observational study of two interventions and standard care. The interventions involved extensive (A) or limited (B) task delegation from general practitioners to hospital-liaised nurses specialised in diabetes and included a diabetes register, structured recall, facilitated generalist-specialist communication, audit and feedback, patient-specific reminders, and emphasised patient education. The target population consisted of 2660 patients with type 2 diabetes treated in the primary care setting. Patients who were terminally ill or who had been diagnosed with dementia were excluded from the study. RESULTS: The participation rates were high (90%) for patients, and none of the 64 GPs discontinued their participation in the study. Longitudinal analyses showed significant improvements in quality indicators for both intervention groups (process parameters and achieved target values on the individual patient level); in standard care, performance remained stable or deteriorated. Both patients and caregivers appeared satisfied with the project. CONCLUSION: This study shows that structured shared care with task delegation to nurses, targeted at a large unselected general practice population, is feasible and can positively affect the quality of care for patients with type 2 diabetes.

Aged↗
PubMed2005

Cross-sectional relationship between glycaemic control, hyperglycaemic symptoms and quality of life in type 2 diabetes (ZODIAC-2).

BACKGROUND: To describe the relationship between glycaemic control, hyperglycaemic symptoms and quality of life (HRQOL) in type 2 diabetic patients. METHODS: In a shared-care diabetes project HRQOL was assessed. A total of 1664 patients with type 2 diabetes were identified in 32 primary healthcare practices. Of these patients, 1149 were included. HRQOL was measured using a generic questionnaire (Rand-36), completed by 1006 of the 1149 participants. RESULTS: The number of hyperglycaemic symptoms was higher in women (1.88) compared with men (1.64), without differences in mean haemoglobin A1c (HbA1c) (7.5%)-Univariate analyses showed negative relationships between all dimensions of the Rand-36 and hyperglycaemic symptoms (p<0.001), but between only one dimension and HbA1c (p=0.005). Multivariate analyses showed no association between any of the dimensions of the Rand-36 and HbA1c, but the relationship between hyperglycaemic symptoms persisted in all dimensions (p<0.001). Notwithstanding these results, the presence of hyperglycaemic symptoms was related to higher HbA1c. CONCLUSION: In type 2 diabetic patients, as assessed by a generic questionnaire, there is an evident relationship between hyperglycaemic symptoms and HRQOL and not between HbA1c and HRQOL. Subjective hyperglycaemic symptoms are, independent of HbA1c, important for HRQOL in type 2 diabetic patients, and should therefore not be neglected in the management of diabetes.

Aged↗
PubMed2004

[Microalbuminuria in patients with type 2 diabetes mellitus in general practice].

OBJECTIVE: Determine the prevalence of microalbuminuria in patients with type 2 diabetes mellitus (DM) in general practice, as an independent risk factor for cardiovascular diseases. DESIGN: Prospective, descriptive. METHOD: Data were collected on patients with type 2 DM in the Zwolle region of the Netherlands, all of whom were being treated by their general practitioner. The inclusion period was 1 February 2000-31 January 2001. The study formed part of a larger investigation, in which the albumin concentration in a urine sample and the albumin-creatinin ratio were determined once per year. A total of 32 general practitioners took part in the study. RESULTS: In the general practices studied, 2094 patients were known with type 2 DM and 1653 (79%) were treated exclusively by the general practitioner. Of these 1653 patients, 67 (4%) were excluded and of the 1586 invited patients remaining, 1441 (91%) participated. Microalbuminuria was present in 33% of the patients and macroalbuminuria in 7% of the patients, and the prevalences increased with age: < 50, 50-70 and > 70 years. 18% (6/33) of the patients aged < 50 years with microalbuminuria were treated with an ACE inhibitor or angiotensin II antagonist compared to 33% (183/548) of patients > or = 50 years. 91% (488/539) of the patients > or = 50 years with microalbuminuria had hypertension and/or lipid profile abnormalities and 82% (402/488) of them were not treated or did not receive adequate treatment for this condition. CONCLUSION: Microalbuminuria and macroalbuminuria were present in respectively 33% and 7% of the patients with type 2 DM in primary care. The treatment of hypertension and lipid profile abnormalities was often inadequate. Therefore, screening patients aged 50 years and older with type 2 DM for albuminuria is justified.

Age Factors↗
PubMed2004

Increased alpha-linolenic acid intake lowers C-reactive protein, but has no effect on markers of atherosclerosis.

OBJECTIVE: To investigate the effects of increased alpha-linolenic acid (ALA)-intake on intima-media thickness (IMT), oxidized low-density lipoprotein (LDL) antibodies, soluble intercellular adhesion molecule-1 (sICAM-1), C-reactive protein (CRP), and interleukins 6 and 10. DESIGN: Randomized double-blind placebo-controlled trial. SUBJECTS: Moderately hypercholesterolaemic men and women (55 +/- 10 y) with two other cardiovascular risk factors (n = 103). INTERVENTION: Participants were assigned to a margarine enriched with ALA (fatty acid composition 46% LA, 15% ALA) or linoleic acid (LA) (58% LA, 0.3% ALA) for 2 y. RESULTS: Dietary ALA intake was 2.3 en% among ALA users, and 0.4 en% among LA users. The 2-y progression rate of the mean carotid IMT (ALA and LA: +0.05 mm) and femoral IMT (ALA:+0.05 mm; LA:+0.04 mm) was similar, when adjusted for confounding variables. After 1 and 2 y, ALA users had a lower CRP level than LA users (net differences -0.53 and -0.56 mg/l, respectively, P < 0.05). No significant effects were observed in oxidized LDL antibodies, and levels of sICAM-1, interleukins 6 and 10. CONCLUSIONS: A six-fold increased ALA intake lowers CRP, when compared to a control diet high in LA. The present study found no effects on markers for atherosclerosis. SPONSORSHIP: The Dutch 'Praeventiefonds'.

Adult↗
PubMed2003

[Consultative palliative care for nausea and vomiting in the home setting].

Two patients with terminal cancer, a 46-year-old man with intestinal obstruction and a 12-year-old boy with a brain tumour, were suffering from vomiting and from headaches and nausea, respectively. Their general practitioners consulted the general-practitioner adviser about palliative treatment. After the recommended changes in medication the symptoms decreased in both patients. They died some weeks later. Nausea and vomiting may be treated when one takes into account which centres in the brain and neurotransmitters are involved, together with the site of action of the medication. The medication may be administered by subcutaneous infusion.

Antineoplastic Agents↗
PubMed2003

[Issues involved in Dutch general practitioners' failure to request autopsy: report from three focus groups].

OBJECTIVE: To investigate which reservations to autopsy general practitioners (GPs) experience in themselves and in relatives of the deceased. DESIGN: Focus-group discussions. METHOD: Three focus-group discussions were organised (24 GPs in total), comprising the following three types of GP: those involved in the training of new GPs, those who were able to request autopsies without encountering practical obstacles, and those who did have to overcome these obstacles when requesting an autopsy. RESULTS: Neither training nor day-to-day functioning as a GP equips Dutch physicians in regarding autopsy as a research tool. The reservations experienced by the GPs were based on emotional issues, organisational obstacles, and financial considerations.

Autopsy↗
PubMed2003

Prevalence, incidence and mortality of type 2 diabetes mellitus revisited: a prospective population-based study in The Netherlands (ZODIAC-1).

BACKGROUND: To present actual data to estimate prevalence, incidence and mortality of known type 2 diabetes mellitus in all age categories in The Netherlands. METHODS: Prospective population-based study between 1998 and 2000 in The Netherlands. Baseline population of 155,774 patients, registered with 61 general practitioners participating in the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC)-study. RESULTS: Age- and sex-adjusted prevalence of type 2 diabetes was 2.2% at baseline and 2.9% after 2 years of follow-up; for women and men it was 3.1 and 2.7% at follow-up, respectively. Patients aged >70 years account for almost 50% of all type 2 diabetes patients. Age- and sex-adjusted mean annual incidence per 10,000 over 3 years was 22.7 overall; for women 23.1 and for men 22.2. Incidence--even though high--decreases after the age of 70 years. The mortality rate was 47.9/1000 and standardised mortality ratio 1.40. Based on these results, the estimated total number of subjects known with type 2 diabetes was 466,000 for The Netherlands in 2000; the number of patients with newly diagnosed diabetes 36,000. CONCLUSIONS: Prevalence and incidence rates exceed all estimates regarding known type 2 diabetes for The Netherlands. Elderly patients, aged 70 years and over, account for 50% of the type 2 diabetic population. These results are important for health-care planning.

Adolescent↗
PubMed2003

Quality of life of patients with type I diabetes mellitus.

The objective of this study was to assess health related quality of life (QOL) in patients with type I diabetes mellitus (DMT1) and to compare their QOL with the QOL of persons of comparable age in the general population. Furthermore we wanted to investigate which factors mostly influence QOL. In a Dutch cohort of 281 patients with DMT1 QOL was assessed using two generic instruments: the EuroQol and the RAND-36. We performed regression analyses to investigate relationships between several demographic (e.g. sex, age, marital status) and diabetes-specific variables (e.g. HbA1c, frequency of insulin injection, presence of acute and chronic complications) and QOL. The Spearman rank correlations between RAND-36 domains and EuroQol were analysed. RAND-36 results showed, for almost all domains, a QOL comparable with persons of comparable age in the general population. In contrast the QOL measured with the EuroQol was lower for subjects with DMT1. Hyperglycaemic complaints and macrovascular complications had a profound negative influence on QOL. Most correlations between the RAND-36 results and the EuroQol results corresponded with our expectations. Longitudinal data and comparison with results of several diabetes-specific questionnaires should help to establish which instrument might be most appropriate to measure QOL in patients with DMT1.

Adult↗
PubMed2003

Prediction of coronary heart disease: a comparison between the Copenhagen risk score and the Framingham risk score applied to a Dutch population.

OBJECTIVES: To compare the estimation of coronary heart disease (CHD) risk by the Framingham risk score (FRS) and the Copenhagen risk score (CRS) using Dutch population data. DESIGN: Comparison of CHD risk estimates from FRS and CRS. CHD risk-estimations for each separate risk factor. SETTING: Urk, the Netherlands. SUBJECTS: A total of 408 fishermen from Urk, aged 30-65 years, without pre-existing cardiovascular disease. MAIN OUTCOME MEASURES: Absolute CHD risk estimates. RESULTS: The average 10-year risk for CHD was significantly different between the FRS (4.6%, SD 5.0) and the CRS (3.2%, SD 4.1). The correlation between the two estimates was 0.94 (P < 0.001). The Bland-Altman figure shows a large proportion of agreement, but with an increasing difference with increasing average risk. When examining the separate risk factors age, total cholesterol, HDL cholesterol and systolic blood pressure and smoking, there appear differences between the two risk functions. CONCLUSION: Using Dutch population data, differences were found for the calculation of CHD risk with the FRS and the CRS. Further research must be carried out to examine the validity of these risk functions in the Dutch population.

Adult↗
PubMed2002

[Physicians for ten years: a longitudinal survey of the career development of physicians who began their studies in Groningen, the Netherlands].

OBJECTIVE: To analyse the career development of two cohorts of medical graduates from the University of Groningen, the Netherlands. DESIGN: Structured interviews. METHOD: For all 333 graduates who commenced undergraduate medical training in 1982 and 1983, data were collected for the period 1993-2000 with respect to resident training, income, job load, job satisfaction and scientific research. Gender differences were analysed for all of the variables. This was done by means of structured interviews as well as a strategic search in Medline and the on-line public catalogue of the University of Groningen. RESULTS: In the year 2000, 73% of the graduates had enrolled in resident training, 8% had not succeeded in finding a place. The wish to work part-time had increased strongly over the years. In general, job satisfaction was reasonable. In total 31% of the cohort had published one or more English articles or written a thesis. Gender differences were found for job load and publications. CONCLUSIONS: Ten years after graduation, medical careers had become established. Men had not succeeded in fulfilling their wishes to work part-time. Women were disadvantaged with respect to their scientific career.

Career Choice↗
PubMed2002

[Hospital care at home; a review of the literature on the effects of a form of transmural care].

OBJECTIVE: To evaluate the effects of hospital at home on health outcomes and quality of life of patients and carers; to evaluate the costs of this form of care and the experiences of the (para)medics involved. DESIGN: Literature study. METHOD: Using Medline, EMBASE-Excerpta Medica, Sci-search and Cinahl, a search was carried out for Dutch- and English-language studies from 1990-2001 which compared hospital at home with conventional inpatient care. RESULTS: Twenty-seven (randomised) controlled trials and cross-over studies from seven different countries were found, which resulted in 37 publications. No differences were found in health outcomes between patients allocated to hospital at home and inpatient care, providing there was careful patient selection and the home met a number of basic conditions. Patients and their carers rated hospital at home positively. The expected reduction in costs to the health services was disappointing. Good organisation, communication and funding were essential boundary conditions to the success of this form of care. Health benefits appear to be primarily attained with schemes designed to avoid admission to hospital for the elderly.

Cross-Over Studies↗
PubMed2001

Towards improvement of the accuracy and completeness of medication registration with the use of an electronic medical record (EMR).

BACKGROUND: Approximately 80% of GPs use a GP information system (GIS) and an electronic medical record (EMR) in their daily practice. To reap the full benefits of an EMR for patient care, post-graduate education and research, the data input must be well structured and accurately coded. OBJECTIVES: The quality and user-friendliness of the software positively influence the completeness and reliability of the data recorded in the GIS. To assess this in actual practice, this study examined whether or not an increase occurred in the accuracy and completeness of indication-related medication registration after the GIS's software package was upgraded. METHOD: GPs recorded data for the Registration Network Groningen (RNG) concerning four medication groups: insulin, trimethoprim, the contraceptive pill and beta-blocking agents. The completeness and accuracy of the registered data were assessed both before and after the change to the new software package. The completeness is evaluated on the basis of the indications missing for the prescribed medications. To assess accuracy, a check was made to determine whether the indications corresponded to those deemed relevant for that particular medication according to National Pharmaceutical Guidelines. RESULTS: The percentage of missing indications decreased notably, especially in the chronically prescribed medication groups. For insulin, the percentage decreased from 40.5 to 3% and for the contraceptive pill from 34.5 to 1%. For trimethoprim, the percentage decreased from 10 to 1%, and for beta-blocking agents from 22 to 1.5%. Of the indications present, the percentage of relevant indications showed a slight increase, with the largest increase observed for the contraceptive pill where the percentage rose from 86 to 96%. CONCLUSIONS: The completeness of recorded indications improved considerably after the change of software. This is due mostly to the efforts of the GPs, their practice assistants and the support of the RNG organization involved in the conversion procedure. Accuracy improved slightly, especially due to the software modifications which ensured that non-existent codes could not be entered. To summarize, with increased user-friendliness of the software, combined with the training of motivated GPs, the quality of recorded data improved.

Adrenergic Antagonists↗
PubMed2001

Family members' experiences of autopsy.

BACKGROUND: The experiences of family members will teach us how to handle an autopsy, the ultimate quality assessment tool. OBJECTIVE: The aim of this study was to determine surviving family members' experience of autopsy. METHOD: Seven GPs were asked to approach surviving family members of autopsied patients to ask for their co-operation with an interview about their experiences. The interview took place at the residences of the individual families, 6 months to a year after the autopsy. A partially structured set of interview questions was used by the interviewer (not a GP) who had experience with the grieving process and with grief counselling. RESULTS: Twelve family members of autopsied patients were interviewed: six partners, three mothers, one offspring and two sisters. In the case of one 35-year-old man, the autopsy was performed as a judicially required post-mortem. The GP initiated the autopsy request in eight cases. It appears that there is definite room for improvement in how the GP handles the topic of autopsy. The best way to explain it is to compare an autopsy with an operation. Several family members had specific concerns about the appearance of their relative after the autopsy. Several of the family members indicated that they were reassured by the autopsy results. Clarity about the cause of death was important, and reassurance that they had not overlooked important symptomatology helped the family members in their grieving process. CONCLUSION: A request for autopsy is one of the most difficult questions which has to be asked at a very difficult time. Three main considerations were important for the relatives: they wanted an answer to the questions "Is there something I overlooked", "How could this have happened" and "Are there hereditary factors which could have consequences for the rest of the family?" The GP is the optimal professional to discuss the autopsy report with the surviving family members. The best approach for the GP includes an open attitude, paying attention to informing the family and supporting their grieving process.

Adaptation, Psychological↗