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Biomedical subjects

C van Weel

Publications and source records attributed to C van Weel.

At least 181 records · Page 10Linked to original sources
PubMed1991

Assessing the functional status during an asthma attack with Dartmouth COOP charts. Validity with respect to the change in asthma.

The functional status of patients was determined during an acute attack of asthma requiring medical intervention. Patients were recruited during two months from general practice: all 28 patients consulting for an acute asthma attack were invited to take part: four refused or were withdrawn from follow up. Matched control patients with asthma, not suffering from an acute attack were selected from the practice file. Patients were investigated directly after the initial intervention and exactly 14 days later: respiratory symptoms, peak expiratory flow rates and functional status were recorded. In all cases the intervention resulted in the relief of symptoms and a return of peak expiratory flow to the normal predicted range for age, sex and height. After the 14 days, patients had no longer evidence of an exacerbation of their asthma. During the attack, there were indications of reduced physical and psychological functions, and reduced daily and social activities. A difference was found in the functional profile of asthmatics with an asthma attack and asthmatics without an asthma attack. After 14 days, the functional status of all the dimensions had improved. There was no evident correlation to the change in functional status and peak expiratory flow rates. An asthma attack hampers the patient in his daily functioning--not only physically, but also in social functioning and feelings. There are indications that the recuperation in terms of functioning takes longer than the symptoms to disappear or the peak expiratory flow to return to normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1991

Value of the patient's case history in diagnosing urinary incontinence in general practice.

What is the value of the case history in diagnosing urinary incontinence in general practice? A total of 103 women with urinary incontinence presented to their general practitioner (GP) and underwent a standard history-taking, physical examination and urodynamic testing. The urodynamic diagnoses were analysed against symptoms and symptom complexes. Symptoms of stress incontinence in the absence of symptoms of urge incontinence had a sensitivity of 78%, specificity of 84% and predictive value of 87%. Symptoms of urge incontinence in the absence of symptoms of stress incontinence excluded genuine stress incontinence. Information on age, parity, enuresis, nocturia, frequency, urgency, cystocele, prolapse and hysterectomy did not contribute to a correct diagnosis. It was concluded that urodynamics are unnecessary in most women presenting with urinary incontinence in general practice.

Adult↗
PubMed1991

Effects of allergy and age on responses to salbutamol and ipratropium bromide in moderate asthma and chronic bronchitis.

The bronchodilating responses to 400 micrograms salbutamol and 80 micrograms ipratropium bromide were studied in 188 patients with chronic bronchitis (n = 113) or asthma (n = 75) and mild to moderate airflow obstruction (forced expiratory volume in one second (FEV1) above 50% but below 2 SD of predicted value) in a crossover study on two days a week apart. Both the patients with asthma and the patients with chronic bronchitis varied considerably in their responses to the salbutamol and the ipratropium bromide. The mean increase in FEV1 in the subjects with asthma was higher after salbutamol (0.371 or 18% of the prebronchodilator value) than after ipratropium bromide (0.26 1 or 13%). In chronic bronchitis there was no difference between the increase in FEV1 after salbutamol (0.161 or 7%) and after ipratropium bromide (0.191 or 8%). When patients were categorised into those with a better response to salbutamol 400 micrograms and those with a better response to ipratropium bromide 80 micrograms, patients with chronic bronchitis responded better in general to ipratropium bromide whereas asthmatic patients responded better to salbutamol. The response pattern was also related to allergy and age, allergic patients and patients under 60 being more likely to respond better to salbutamol 400 micrograms than non-allergic patients and older patients, who benefited more from ipratropium bromide 80 micrograms. The response pattern was not related to sex, smoking habits, lung function, bronchial reactivity, respiratory symptoms, or number of exacerbations during the preceding year.

Age Factors↗
PubMed1991

Do physical signs reflect the degree of airflow obstruction in patients with asthma or chronic obstructive pulmonary disease?

UNLABELLED: The aim of the study was to relate the physical signs of the chest to the degree of airflow obstruction in asthma and COPD. METHODS: 113 patients with COPD and 76 patients with asthma were recruited from general practice. A standard physical examination of the chest was performed by trained medical students. Physical signs were related to the degree of airflow obstruction. RESULTS: the signs correlating closely with the degree of airflow obstruction were: a prolonged expiratory phase, low-standing diaphragm, decreased expiratory breath sounds, noisy inspiratory sounds, and decreased diaphragmatic excursions. There was a fair correlation between the number of physical signs and the degree of airflow obstruction. This was especially the case in asthma (r = 0.62), but it was less clear in COPD (r = 0.45). Sensitivity of separate physical signs to detect airflow obstruction was less than 50%, but at least one of the signs was present in 70% of the patients with obstruction. Specificity of separate signs was more than 85%, apart from wheezing in asthma. CONCLUSION: the combination of physical signs can offer relevant information in monitoring the severity of airflow obstruction in asthma and COPD.

Adult↗
PubMed1991

Controlled trial of pelvic floor exercises in the treatment of urinary stress incontinence in general practice.

The aim of this study was to assess the usefulness of pelvic floor exercises in the treatment of urinary incontinence in women and to analyse the factors which determine a successful outcome. The study involved 66 women who had reported 'genuine stress incontinence' to their general practitioner. They were assigned at random to the treatment or control group. The treatment group received instructions in pelvic floor exercises from a general practitioner. The control group received no therapy. At the start of the trial the severity of the patients' incontinence was assessed objectively. This assessment was repeated after three months and patients were also asked for their own perception of whether their incontinence had improved. After the three months' evaluation the patients in the control group were also given instructions in pelvic floor exercises. After another three months they were assessed in the same way. About 60% of the patients in the treatment group were dry or mildly incontinent after three months compared with only one patient in the control group; the mean weekly frequency of incontinence episodes fell from 17 to five in the treatment group but remained virtually unchanged in the control group; and about 85% of the women in the treatment group felt that their incontinence had improved or was cured compared with no one in the control group. These results were later corroborated by those for the control group. The most important factor in the success of the treatment was the patients' motivation, as demonstrated by their adherence to the daily exercises.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Accuracy, precision and linearity of the portable flow-volume meter Microspiro HI-298.

The accuracy, precision and linearity of a new portable flow-volume meter, the Microspiro HI-298 (Chest Corporation, Tokyo, Japan), was investigated using a Fleisch no. 4 pneumotachograph as a standard. After connection and calibration of the pneumotachograph and the Microspiro, a healthy subject performed 44 forced vital capacity (FVC) manoeuvres at different levels of lung inflation. The FVC of these expirations ranged from 2.5-5.1 l. Linear regression of Microspiro values (dependent variable) on Fleisch pneumotachograph values (independent variable) showed that a good linear relationship existed: Pearson correlation coefficients ranged from 0.938-0.985. Linearity of the Microspiro was good except for the peak expiratory flow rate (PEFR) and the maximal expiratory flow at 25% of the expired volume (MEF75). The random error (measure of precision) of all flow-volume (F-V) indices was lower than 5%. The systematic error (measure of accuracy) was low for the forced expiratory volume in one second (FEV1) and the FVC (1% and 4.6%, respectively) but much higher for the instantaneous expiratory flows (PEFR 11.0%; MEF75 7.0%; MEF50 8.5%; MEF25 11.4%). Only the total error in FEV1 complied with the tolerance of 4% of the European Community for Coal and Steel (ECCS). When the measured values were adjusted according to the regression equations of this study, all F-V indices were accurate and precise within 5%. It was concluded that the portable Microspiro HI-298 is a useful instrument for bedside, work-site spirometry and for use in general practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1990

Increased bronchial hyperresponsiveness after inhaling salbutamol during 1 year is not caused by subsensitization to salbutamol.

Recently, it was suggested that long-term administration of an inhaled beta 2-agonist might increase bronchial hyperresponsiveness (BHR) to histamine, possibly as a consequence of subsensitization to the inhaled beta 2-agonist. To test this hypothesis, we studied two groups of patients with asthma or with chronic obstructive pulmonary disease. An experimental group of 15 patients, inhaling 400 micrograms of salbutamol four times daily during 1 year and subsequently 40 micrograms of ipratropium bromide four times daily for 6 months, and a control group, consisting of 22 patients with the opposite treatment regimen. The BHR, the response in FEV1 to cumulative doses of salbutamol, and the number of beta 2-adrenoceptors and antagonist affinity of these receptors on circulating lymphocytes were assessed at the start of the study and at 6-month intervals for 1 1/2 years. The BHR increased significantly (p = 0.001) during the year salbutamol was inhaled and returned to about the value at the start of the study after inhaling ipratropium bromide for 6 months. No change occurred in the bronchodilating responses to cumulative doses of salbutamol, nor was any change observed in the number and the affinity of beta 2-adrenoceptors on lymphocytes. It was concluded that long-term use of salbutamol caused a small but significant increase in BHR. The increase in BHR was not caused by subsensitization of beta 2-adrenoceptors to salbutamol.

Administration, Inhalation↗
PubMed1990

Evaluation of the Phadiatop test in an epidemiological study.

Sera from 204 adult patients with chronic airways obstruction were analysed with the Phadiatop, a new allergosorbent test with a paper disc containing the most relevant inhalant allergens, the PRIST for total IgE determinations, and a panel of seven RAST tests with the common inhalant allergens in The Netherlands as reference. The aim was to evaluate the Phadiatop as screening test in the in vitro diagnostic procedures in an epidemiological setting. The Phadiatop was classified positive or negative according to percentage binding, total IgE was considered elevated at values greater than 100 kU/l and the RAST panel positive when at least one RAST result was class greater than 1. The prevalence of inhalant atopy came to 27.9%. The predictive value of the Phadiatop for a positive RAST panel was 96.4%, and for a negative RAST panel 97.3%. For the PRIST these values were 51.9% and 87.2% respectively. The correlation between the log percentages binding of the Phadiatop and the RAST panel was 0.93. It is concluded that the Phadiatop is a valuable test for the screening of inhalant atopy, and as the percentage binding of the Phadiatop may reflect the degree of sensitization it could also be applied as a quantitative measure especially for epidemiological purposes.

Adult↗
PubMed1990

Diagnosing diabetic retinopathy by general practitioners and by a hospital physician. The use of fundus photos.

Five non-ophthalmologists (four general practitioners and a hospital physician) assessed the retinal status of 62 patients with diabetes mellitus, using fundus photos. They had no particular interest in diabetic retinopathy, nor did they receive special training. Their diagnoses were compared with the diagnostic opinion of two ophthalmologists, whose diagnoses served as the standard. The use of reference charts (photos of normal retinas and retinas with diabetic retinopathy) reduced the number of false negative assessments. The sensitivity of the non-ophthalmologists varied between 100 per cent and 88 per cent, depending on the standard (diagnosis of one ophthalmologist or consensus between two ophthalmologists). The specificity was 55 percent, indicating the potentially high rate of inappropriate referral. The coefficient of agreement of diagnosis between the non-ophthalmologists and the ophthalmologists was kappa 0.54. All but one patient put on treatment by the ophthalmologists had been identified by the non-ophthalmologists. The possibility of fundus photography in patient management (consultation on photo reading instead of a referral of the patient) is discussed. It is concluded that the assessment of fundus photos to detect diabetic retinopathy by general physicians seems to be a promising strategy in the surveillance of patients with diabetes mellitus.

Clinical Competence↗
PubMed1990

Accuracy and reproducibility of the Assess peak flow meter.

The variability of peak flow measurements was studied in 24 patients with airway obstruction, using 12 Assess peak flow meters and a Fleisch pneumotachograph type 4 as a standard. The Assess peak flow meter gave systematic under-readings of 19-34% (low accuracy). The value scale of the Assess peak flow meter should be adjusted. As systematic under-readings do not influence the variability in peak flow measurements, variability was only caused by the random error of the instrument. The random error of the Assess peak flow meter was relatively low: about 4% of the measured peak flow value (high precision). The contribution of the Assess peak flow meter to the total variability of peak flow measurements showed a linear relationship (r = 0.53) with the value of the peak flow rate itself and varied from 9% (at 3 l.s-1) to 86% (at 10.8 l.s-1). Reading errors of the peak flow meter were responsible for about 1% of the total variability. The remaining variability is probably caused by the correctness of the peak flow performance and the motivation of the patient.

Adult↗
PubMed1989

[The correlation of transient ischemic attack and cerebrovascular accident].

Correlation exists between the occurrence of a transient ischemic attack (TIA) and a cerebrovascular accident (CVA). The strength of this correlation however is a point for debate. We studied the sequential relation between the occurrence of TIA and CVA in patients over 50 years in general practice. Based on Continuous Morbidity Registration (CMR) in four general practices we analysed the morbidity in patients who presented symptoms of TIA and (or) CVA during the period 1971-1983. In this period a TIA was diagnosed in 134 persons and a CVA in 214 persons. The maximal observation period of the TIA patients after presentation of the symptoms was 12 1/2 years. In 8% of the CVA cases a TIA had been diagnosed in the period preceding the CVA. Of the TIA patients 13% developed a CVA in the subsequent observation period, half of them within two years after the TIA diagnosis. Comparison of the incidence rate of CVA in the general population with that in the population with a TIA reveals that a CVA development is about six times more frequent in the latter. This higher risk has only a relative meaning because the absolute number of cases is small.

Cerebrovascular Disorders↗