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C Van Weel

Publications and source records attributed to C Van Weel.

At least 19 recordsLinked to original sources
PubMed2003

Self-management of asthma in general practice, asthma control and quality of life: a randomised controlled trial.

BACKGROUND: A study was undertaken to determine the effectiveness of asthma self-management in general practice. METHODS: Nineteen general practices were randomly allocated to usual care (UC) or self-management (SM). Asthma patients were included after confirmation of the GP diagnosis. Follow up was 2 years. Patients kept diary cards and visited the lung function laboratory every 6 months. Outcomes were number of successfully treated weeks, limited activity days, asthma specific quality of life, forced expiratory volume in 1 second (FEV(1)), FEV(1) reversibility, concentration of histamine provoking a fall in FEV(1) of 20% or more (PC(20) histamine), and amount of inhaled steroids. RESULTS: A total of 214 patients were included in the study (104 UC/110 SM; one third of the total asthma population in general practice); 62% were female. The mean percentage of successfully treated weeks per patient in the UC group was 72% (74/103 weeks) compared with 78% (81/105 weeks) in the SM group (p=0.003). The mean number of limited activity days was 1.2 (95% CI 0.5 to 1.9) in the SM group and 3.9 (95% CI 2.5 to 5.4) in the UC group. The estimated increase in asthma quality of life score was 0.10 points per visit in the UC group and 0.21 points per visit in the SM group (p=0.055). FEV(1), FEV(1) reversibility, and PC(20) histamine did not change. There was a saving of 217 puffs of inhaled steroid per patient in favour of the SM group (p<0.05). CONCLUSION: Self-management lowers the burden of illness as perceived by patients with asthma and is at least as effective as the treatment usually provided in Dutch primary care. Self-management is a safe basis for intermittent treatment with inhaled corticosteroids.

Adult↗
PubMed2002

Potential masking effect on dyspnoea perception by short- and long-acting beta2-agonists in asthma.

Asthma patients evaluate the effect of medication treatment through the degree of their asthma symptoms, which might be affected by their ability to perceive these symptoms. It has been suggested that beta2-agonists may mask the effects of an increase in airway inflammation. This study compared the perception of histamine-induced bronchoconstriction during monotherapy with short- or long-acting beta2-agonists. Asthmatic patients (68 male and 60 female, mean age 35+/-11 yrs, forced expiratory volume in one second (FEV1) 86+/-15% of the reference value, provocative concentration causing a 20% fall in FEV1 (PC20) geometric mean 0.97 mg x mL(-1) (95% confidence interval (CI): 0.73-1.30)) were selected and randomly allocated to use either a short-acting (salbutamol, n=41) or long-acting beta2-agonist (formoterol, n=46) or placebo (n=41) for 12 weeks. Perception of dyspnoea provoked by histamine-induced bronchoconstriction was measured at the start and every 4 weeks thereafter. Subjects quantified their sensation of breathlessness during the challenge tests on a modified Borg scale at the start of the study and every 4 weeks thereafter. The sensitivity to changes in FEV1 was analysed by the linear regression slope (alpha) Borg versus % fall in FEV1. The absolute perceptual magnitude (PS20) was determined by the perception score at the 20% fall in FEV1. Although the geometric mean PC20 decreased significantly within the group using short-acting beta2-agonists (in the group with initial PC20 > or = 2 mg x mL(-1) there was a drop from 5.26-1.94 mg x mL(-1); p=0.013), repeated measurement analysis showed no difference in the course of time of perception (both slope alpha and PS20) between the three medication groups. This study showed that chronic use of short- or long-acting beta2-agonists in asthmatics for a period of 12 weeks, did not significantly change the perception of histamine-induced bronchoconstriction compared with placebo. Further investigation is required to establish whether this suggests that these drugs do not mask a deterioration of asthma.

Adolescent↗
PubMed1999

Perception of bronchoconstriction in asthma patients measured during histamine challenge test.

This study investigated two aspects of the perception of bronchoconstriction ("sensitivity" and "absolute perceptual magnitude") in asthmatic patients and identified which clinical characteristics are related to these two aspects of perception of bronchoconstriction. The perception of histamine induced bronchoconstriction was measured in 128 asthmatic patients. Subjects quantified their breathlessness on a Visual Analogue Scale (VAS) before forced expiratory volume in one second (FEV1 was measured after each inhalation of histamine. The perceptive "sensitivity" for changes in FEV1 was analysed by the "VAS percentage fall in FEV1" slope. The "absolute perceptual magnitude" was determined by the VAS value at a 20% fall in FEV1. Spearman correlations were used for analysis between the two aspects of perception and asthma symptoms, peak flow variability, bronchial responsiveness and FEV1 % predicted. Patients with a low "sensitivity" for changes in FEV1 were more likely to show a frequent peak flow variability (Rs=-0.21; p<0.05), a high bronchial responsiveness (Rs= 0.37; p<0.001) and a low baseline FEV1 % pred (Rs=0.22; p<0.05). Patient's "absolute perceptual magnitude" correlated positively with symptoms during daily life (significant correlations varied 0.21-0.32) but not with the lung function parameters. The severity of asthma reflected by a low lung function and a high bronchial responsiveness, is associated with a low "sensitivity" for changes in forced expiratory volume in one second. A patient's "absolute perceptual magnitude" is positively related with asthma symptoms during daily life.

Adult↗
PubMed1998

Relationship between practice organization and cardiovascular risk factor recording in general practice.

BACKGROUND: Research findings suggest that the level of cardiovascular risk factor recording in general practice is not yet optimal. Several studies indicate a relation between the organization of cardiovascular disease prevention at practice level and cardiovascular risk factor recording. AIM: To explore the relation between the organization of cardiovascular disease prevention and risk factor recording in general practice. METHOD: A cross-sectional study was conducted using data on adherence to selected practice guidelines and on cardiovascular risk factor recording from 95 general practices. Practice guidelines were developed beforehand in a consensus procedure. Adherence was assessed by means of a questionnaire and practice observations. Risk factor recording was assessed by an audit of 50 medical records per practice. RESULTS: Factor analysis of risk factor recording revealed three dimensions explaining 76% of the variance: recording of health-related behaviour, recording of clinical parameters, and recording of medical background parameters. Adherence to the guideline 'proactively invite patients to attend for assessment of cardiovascular risk' was related to a higher recording level in all three dimensions. Practice characteristics did not show a consistent relationship to the level of risk factor recording. CONCLUSION: This study indicates that the presence of a system of proactive invitation was related to the recording of cardiovascular risk factors in medical records in general practice.

Adult↗
PubMed1996

Home birth.

Explore the source record for details and available documents.

Female↗
PubMed1996

Evaluation of the suitability of weekly peak expiratory flow rate measurements in monitoring annual decline in lung function among patients with asthma and chronic bronchitis.

BACKGROUND: Early detection and treatment of patients with asthma or chronic bronchitis who have a rapid annual decline in lung function is essential in order to improve their long-term prognosis. This annual rate of decline can be assessed accurately by monitoring the forced expiratory volume in one second (FEV1) which is a routine procedure in hospital respiratory laboratories but not in general practice. General practitioners usually measure patients' peak expiratory flow rate (peak flow) to evaluate lung function. If annual decline in lung function can be assessed by monitoring peak flow, this method could be used in general practice for detecting patients at an early stage who have a rapid decline. AIM: A study aimed to investigate the long-term correlation between FEV1 and peak flow among a group of patients in Nijmegen, the Netherlands. METHOD: FEV1 and peak flow were monitored in 53 patients with moderate asthma and 78 patients with moderate chronic bronchitis over four years. FEV1 was measured in a laboratory once every six months and peak flow was measured by patients once a week. The correlation between the two sets of measurements was studied for each patient. RESULTS: Four-year data for 83 of the 131 patients were analysed; the other 48 patients received inhaled steroids during the second half of the study period so their data were not considered for all the analyses. Of the 83 patients, 35 (42%) showed a decrease in both FEV1 and peak flow. Thirty six patients (43%) showed a decrease in FEV1 and an increase in peak flow. Four patients (5%) showed an increase in FEV1 and a decrease in peak flow and eight patients (10%) showed an increase in both rates. Approximately similar results were seen in a separate analysis of all 131 patients during the first two years of the study. CONCLUSION: No long-term correlation was found between FEV1 and peak flow. Peak flow is not capable of detecting annual decline in lung function. Therefore it cannot be used to detect patients with asthma or chronic bronchitis who have a rapid annual decline in lung function. Spirometers, which measure peak flow and FEV1, could be used in general practice. These would allow general practitioners to continue measuring peak flow in order to assess short-term changes in lung function while providing an important means for monitoring FEV1 to assess long-term changes in lung function.

Adult↗
PubMed1995

Cellular composition of cervical smears taken by general practitioners.

The quality of the cervical smears taken by general practitioners, and also by some practice assistants, of the Dutch Screening Programme in the region of Nijmegen was evaluated. Of 18,398 preventive cervical smears taken by GPs in this region, 437 (2%) were diagnosed as "class" 0 and 2907 (16%) smears did not contain endocervical cells (EC-). The quality of the smears per general practitioner varied enormously. The percentage of smears without endocervical cells taken by six practice assistants was 18. During the screening period the percentage of smears without endocervical cells taken by GPs decreased from 19 (1989) to 14 (1992). In February 1990 the six practice assistants followed a theoretical and practical course on cervical smear-taking. Remarkable was the decrease in the percentage of smears without an endocervical component from 25% in 1990 to 13% in 1991. The quality of smears taken by GPs would improve if the general practitioner had more experience in smear-taking. We recommend to offer GPs the opportunity to take practical training courses in smear-taking, just as the practice assistants in this project.

Adult↗
PubMed1995

Validating long term morbidity recording.

STUDY OBJECTIVE: To assess the validity of diagnosis made in a general practice based morbidity recording from 1967-90. DESIGN: Clinical features of patients with a diagnosis of migraine headache and diabetes mellitus were compared with international diagnostic criteria for these conditions. For migraine headache the International Classification of Health Problems in Primary Care (ICHPPC) definition was used, while diabetes mellitus was defined according to World Health Organization (WHO) criteria. SETTING: The continuous morbidity registry of the Department of General Practice and Social Medicine, University of Nijmegen, has been recording data from four general practices (12,000 patients) continuously since 1967. The database is used for longitudinal clinical research. PATIENTS: All patients with migraine headache and living in the practice area at the time of study and matched controls with tension headache received a questionnaire asking about ICHPPC criteria symptoms of migraine. The medical records of all patients with diabetes mellitus at the time of diagnosis were compared with WHO criteria. MAIN RESULTS: In 85% of patients with migraine headache, the questionnaire confirmed the ICHPPC defined criteria. Twenty nine per cent of the matched controls reported migraine features. In 74% of the patients with diabetes mellitus the diagnosis was made in agreement with the WHO criteria: in 12% no clinical information from the time of diagnosis could be traced. CONCLUSIONS: The diagnoses of migraine headache and diabetes mellitus in the registry largely agreed with international criteria. The quality control of recorded data is satisfactory, and the registry might serve as a model for other primary care based databases.

Data Collection↗
PubMed1994

Consultation rates and incidence of intercurrent morbidity among patients with chronic disease in general practice.

BACKGROUND: Information on frequency of consultation and presented morbidity among patients with chronic disease is relevant to the management of these patients in view of the increasing prevalence of chronic diseases. AIM: This study set out to examine consultation rates and incidence of intercurrent morbidity in general practice in cohorts of patients with five common chronic diseases: hypertension, chronic ischaemic heart disease, diabetes mellitus, chronic respiratory disease and osteoarthritis. METHOD: In seven practices with 15 general practitioners the records of all patients were screened for inclusion in the study. The data used for analysis were from 962 patients, whose diagnoses were made in agreement with diagnostic criteria, who were not under specialist care, and who were followed up for 21 months. A distinction was made between patients with one, or two or more of the five chronic diseases studied. For the single disease subgroups of patients with hypertension or diabetes two reference groups of people without a chronic disease, standardized for age and sex, were identified from the population in the same practices. RESULTS: Consultation rates were higher for patients with comorbidity than for patients with a single disease. Intercurrent diseases were presented more frequently to the general practitioner by patients with comorbidity than by patients with a single disease. Most intercurrent morbidity consisted of acute common diseases such as myalgia, upper respiratory tract infection and urinary tract infection. Patients with only hypertension or only diabetes had higher consultation rates than the corresponding reference group but did not have higher total incidence rates of intercurrent morbidity. CONCLUSION: Patients with chronic disease consult their general practitioner frequently, and patients with more than one chronic disease consult even more frequently. The general practitioner has to deal with chronic disease and intercurrent acute disease in a single patient.

Adult↗
PubMed1992

Treatment with inhaled steroids in asthma and chronic bronchitis: long-term compliance and inhaler technique.

We investigated compliance and inhaler technique in 50 patients with airway obstruction (26 asthma, 24 chronic bronchitis) being treated with inhaled steroid (beclomethasone dipropionate, BDP) via a dry powder inhaler (Rotahaler omega). Patients had already participated for one year in a 2-year trial of BDP in general practice. They were treated daily with two dry powder inhalations of 400 micrograms BDP in combination with a bronchodilator. Compliance with BDP was measured by counting capsules (single-blind) at the end of a 4-month period and through a questionnaire. Counting capsules revealed non-compliance in 46% of the patients. Compliance was not related to age, sex, diagnosis or side-effects of BDP. In chronic bronchitis, but not in asthma, compliance was related to the outcome parameters of steroid treatment (pulmonary symptoms, change in lung function and non-specific bronchial responsiveness). The inhaler technique was judged insufficient in 27% of the patients. This study stresses the importance of regular instruction in inhaler technique and proper information about prophylactic steroid treatment by the general practitioner during the treatment of asthma and chronic bronchitis.

Administration, Inhalation↗
PubMed1992

Reproducibility of electrocardiographic criteria for left ventricular hypertrophy in hypertensive patients in general practice.

Before changes in ECG voltage criteria can be accepted as evidence for changes in LVH, the variability of ECG measurements must be known. Here we report on the results of a study, on the variability of electrocardiographic single lead voltage parameters and (voltage) criteria for left ventricular hypertrophy in hypertensive patients in general practice. Two electrocardiograms were recorded, from 64 patients at an interval of 2 min, to measure the minute-to-minute variability. From 77 patients, two electrocardiograms were recorded at an interval of one week to measure the day-to-day variability. The coefficient of variation of voltage parameters for single leads ranged in the day-to-day group from 9.2% in R/I to 42% in T/V1, and the coefficient of variation for voltage combinations in this group ranged from 10.0% for the Sokolow-Lyon criteria to 13.7% for Gubner-Ungerleider criteria. The reclassification percentages in the day-to-day group ranged from 0% for Gubner-Ungerleider to 17% for Minnesota code criteria. A factor analysis showed that studies which use the Romhilt-Estes score, the Sokolow-Lyon or the Minnesota criteria to detect ECG-LVH are not comparable with studies which use the Cornell or Gubner-Ungerleider criteria.

Aged↗
PubMed1992

Urinary incontinence in women and the effects on their lives.

The aim of this study was to assess and analyse the effects of urinary incontinence in women and to examine the relationship between these effects and the type and severity of incontinence. 110 women aged 20 to 65 who had reported urinary incontinence to their general practitioners underwent a comprehensive history and a complete urodynamic evaluation. The reported consequences of incontinence included low self-esteem, changing life-style in order to avoid potentially embarrassing situations, and all kinds of practical worries. Fear of the odour played the most important part and was mentioned as being the worst effect in 40% of the cases. Most of the women appeared to cope adequately with the unpleasant aspects of this condition. More effects were associated with urge incontinence than with stress incontinence, while there was a significant relationship between the objective severity of the incontinence and its psychosocial impact. The main conclusion is that although urinary incontinence is not a severe physical disability, a spectrum of psychological problems is associated with it. In particular, the fear of being smelt was of the utmost importance.

Adaptation, Psychological↗
PubMed1992

Psychological aspects of female urinary incontinence in general practice.

The aim of this study was to determine whether urge incontinence was associated with a higher prevalence of psychological symptoms than other types of incontinence. The psychological aspects of 110 women presenting with urinary incontinence in general practice were assessed by means of standardised questionnaires and medical history-taking. The results showed no difference in psychological characteristics between patients with urge incontinence and those with other types of incontinence. These findings were contrary to the conclusions of almost all other studies based on populations selected for specialist care. It was concluded that in general practice the psychological approach to urinary incontinence depends more on the individual needs of the patient than specifically on the type of incontinence.

Adult↗