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Biomedical subjects

C Spreeuwenberg

Publications and source records attributed to C Spreeuwenberg.

33 records · Page 2Linked to original sources
PubMed1991

[Euthanasia and assisted suicide by physicians in the home situation. I. Diagnoses, age and sex of patients].

In order to map out morbidity, age and sex of patients with whom family doctors participated in euthanasia or assisted suicide, an exploratory, descriptive, retrospective study was carried out primarily regarding the period 1986-1989. Data were collected via an anonymous written injury among an at random sample of family doctors in North Holland (n = 521), and family doctors in the rest of the Netherlands (n = 521). In addition, police reports of euthanasia/assisted suicide administered by family doctors in North Holland (n = 263) were analysed. The inquiry included among others questions about the last case doctors had encountered. Diagnoses were classified according to the ICD-9. The results were compared with compiled mortality data relating to persons who died in their own homes. Correlations and differences were analysed by means of the chi2-test. The response to the inquiry was 67% (non-responders did not otherwise differ from responders): 228 (North Holland), 160 (rest of the Netherlands) and 263 (police reports) cases could be analysed. Of the patients, 85% suffered from a malignant neoplasm. The average age at which euthanasia or assisted suicide was practised was 63.4 years (men) and 66.1 years (women). Under the age of 30 and above 85 euthanasia or assisted suicide was administered only rarely. Proportionally these procedures were applied to the same extent to men as to women. In about 20% of the cases an important secondary diagnosis was present. In conclusion, it is especially the malignant neoplasms that cause such suffering that euthanasia or assisted suicide are practised. The average age at which they are applied is considerably lower than that of the total of people who die in their own homes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Euthanasia and assisted suicide by physicians in the home situation. 2. Suffering of the patients].

In order to assess the suffering of patients who died at home and with whom family doctors participated in euthanasia or assisted suicide, an exploratory, descriptive, retrospective study was carried out regarding primarily the period 1986-1989. Data were collected via anonymous written inquiry among an at random sample of family doctors in North Holland (n = 521), and family doctors in the rest of the Netherlands (n = 521). With reference to the last case of euthanasia or assisted suicide they had encountered questions were included about physical and emotional suffering, signs and symptoms and life expectation. Correlations and differences were analysed by means of the chi2-test. The response to the inquiry was 67% (non-responders did not otherwise differ from responders): 228 (North Holland), 160 (rest of the Netherlands) cases could be analysed. Most patients suffered physically as well as emotionally. The most frequently mentioned aspect was 'general weakness or tiredness'. Also 'dependence or being in need of help', loss of dignity, humiliation' and 'pain' were often present to a (very) large extent. At the time the procedure was carried out the life expectation in almost two-thirds of the cases was less than 2 weeks; in 10% of the cases it was more than 3 months. For several reasons, this investigation reduces the possibilities of extrapolation. Further investigation is necessary to determine whether this picture of suffering is specific of this category of patients.

Adult↗
PubMed1990

The association between peer consultations and three aspects of clinical competence.

The relationship between the clinical competence of general practitioners and the degree of peer consultation about diagnostic and therapeutic problems was studied. Three aspects of clinical competence are discerned: attention paid to somatic aspects, patient-orientation and risk of unnecessary harm of the management. Clinical competence has been measured by a written simulation of patient-doctor encounters using five patients and assessment procedures in a study with a correlational design. For this study 49 subjects were selected from a population of 184 GPs who completed their vocational training in general practice at the University of Utrecht between 1975 and 1980. They were selected from those who consult their colleagues frequently and systematically about a variety of patients' problems and from those who do so little or not at all. The 49 subjects did not differ from the remainder in several relevant aspects such as practice setting, subscription to medical journals, etc. The 49 GPs are relatively consistent in the quality of attention they pay to somatic aspects. The consistency with regard to the two other aspects is rather low, especially regarding the risk of unnecessary harm. Attention paid to somatic aspects is connected with patient orientation. The latter is also connected with risk of unnecessary harm, but the former is not. The three aspects are more or less separate aspects of clinical competence. Peer consultation has a direct relationship with quality of attention paid to somatic aspects; GPs who do not consult among peers anyway display a lower quality of attention to somatic aspects in comparison to those who do so.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Competence↗
PubMed1990

Do peer consultations improve quality of care in general practice?

The present study relates to three aspects of quality of care in general practice: attention paid to somatic aspects, patient orientation and risk of unnecessary harm. Quality of care had been measured by (a) a written simulation of patient-doctor encounters, which includes five patients and (b) rating procedures. The study has been carried out in two steps. Firstly several aspects of peer consultation have been investigated in a group of 184 doctors (response rate: 83%), who had their vocational training in the department of General Practice of the University of Utrecht. One third of the GPs consulted colleagues frequently and continued to do so for long periods, dealing systematically with a variety of problems, one third did so infrequently or unsystematically, and one third did little or no consulting at all. A relationship was found between the type of practice and consulting behaviour: 20% of those who practice alone never consulted peers, whereas those in group practices and health centres are accustomed to do so regularly. Secondly, 49 doctors were selected from the 184 mentioned above. The 49 did not differ from the remainder in several relevant aspects such as practice setting, subscription to medical journals, etc. Peer consultation seems to have a direct relationship with the quality of attention paid to somatic aspects; GPs who do not consult among peers in any way display a lower quality of attention to somatic aspects in comparison to the others. In this study these GPs are all solo physicians.(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Medical↗
PubMed1990

Dietary treatment of patients with mild to moderate hypertension in a general practice: a pilot intervention study (1). The first three months.

Thirty-five patients with mild to moderate hypertension were randomised into a three months' dietary advised and a three months' control group. The diet was of a composition currently considered to be appropriate, and was monitored by a dietitian. Statistically significant decreases in diastolic blood pressure, mean arterial pressure, sodium excretion, and low density lipoprotein (LDL)-cholesterol occurred in the intervention group, although differences in change between the intervention and the control group were, except for LDL-cholesterol, not statistically significant. Thus, it did not become clear whether and to what extent change in diet was responsible for the lowering of the blood pressure in the intervention group.

Adult↗
PubMed1990

Dietary treatment of patients with mild to moderate hypertension in a general practice: a pilot intervention study (2). Beyond three months.

In a general primary care practice the feasibility and the effects of dietary counselling in mild and moderate hypertension were studied for a period of 18 months. Significant decreases in blood pressure and sodium excretion compared to baseline occurred, while serum lipids showed transient improvement. Of the original 35 participants, 28 finished the study.

Adult↗
PubMed1989

Diagnostic styles of general practitioners confronted with ambiguous symptoms. An exploratory study.

This study explores the diagnostic process of general practitioners confronted with ill-defined and ambiguous complaints, which eventually appeared to be caused by a malignancy. Three aspects were rated: (a) the adequacy of the initial problem definition; (b) the carefulness of further diagnostic methods; and (c) how the suspicion of malignancy originated. These three aspects, which were strongly connected, seem to be parts of a diagnostic approach with two polar extrems: a critical style and a biased style. Characteristic of a critical style is full awareness of detail, careful observations, consideration of ambiguous symptoms, and consciousness that the correct diagnosis is often other than the one initially judged most likely. The opposite, the biased style, is characterized by little alertness for detail, less careful observations, and overinterpretation of facts supporting the initial hypotheses.

Adult↗
PubMed1988

Consultation among peers in general practice; from no consultation to peer review.

The present study concerned several aspects of peer consultation by general practitioners, investigated in a group of 184 doctors (response rate: 83%) who had their vocational training in the department of general practice of the University of Utrecht and practised for at least three years at the time of the study. Questionnaire responses indicated that consultation during and outside surgery hours and participation in case-discussion groups generally extended over more than two years, occurred frequently, and usually pertained to diverse problems associated with diagnosis and treatment. Participation in study and peer review groups extended usually over a shorter time (1 to 1 1/2 years) and the problems dealt with were predominantly the same as for individual consultation. One-third of the general practitioners consulted colleagues frequently and continued to do so for long periods, dealing systematically with a variety of problems; one-third did so infrequently or unsystematically, and one-third did little or not at all. A relationship was found between the setting of the practice and consulting behaviour: 20% of those who practised alone never consulted peers, whereas those in group practices and health centres were accustomed to do so regularly.

Family Practice↗
PubMedDate not supplied

Effects on quality of care for patients with NIDDM or COPD when the specialised nurse has a central role: a literature review.

Chronic care has to be organised in a way that care from any one caregiver is linked up to that provided by others so that disturbing gaps, contradictions and overlaps are avoided. In the search for the most effective and efficient combination of health professionals to deliver care to chronic patients, the role of the specialised nurse has become important. This article reviews a Medline search for publications about the effects of models of care for patients with NIDDM or COPD in which the specialised nurse has a central role. Main features of the models are identified and related to expected and statistically significant effects. In this young domain of effect evaluation ten publications met our criteria. Depending on the division of tasks between care providers, improvements are seen in self-care, quality of life and patient satisfaction, as well as increased medical consumption. More methodologically suitable evaluations with the use of only valid measures are needed.

Diabetes Mellitus, Type 2↗
PubMedDate not supplied

Meeting at Maastricht.

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Editorial Policies↗