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C van Weel

Publications and source records attributed to C van Weel.

At least 37 records · Page 2Linked to original sources
PubMed2005

Pharmacologic treatment of migraine. Comparison of guidelines.

OBJECTIVE: To compare guidelines (not the primary studies) for pharmacologic treatment of migraine as to methods of guideline development; recommendations, particularly on triptans; and quality of supporting evidence (with emphasis on comparative studies of triptans versus ergot alkaloids and nonsteroidal anti-inflammatory drugs [NSAIDs]). DATA SOURCES: We searched MEDLINE via PubMed for guidelines on migraine management published since 1990 in any language; in addition, we browsed the Internet for information. STUDY SELECTION: We found nine clinical guidelines on migraine; one guideline, not supported by references, was excluded. SYNTHESIS: Preference for triptans is not well founded and is largely based on comparisons with placebo. Too few studies compared new drugs with established ones (NSAIDs or dihydroergotamine). Guidelines that propose a hierarchy for selection of drugs are opinion-based rather than evidence-based. CONCLUSION: The current lack of evidence from comparative studies seriously limits development of evidence-based clinical practice guidelines for pharmacologic treatment of migraine.

Analgesics, Non-Narcotic↗
PubMed2004

Asthma and chronic obstructive pulmonary disease: differences between workers with and without sick leave.

OBJECTIVE: Determinants of sick leave should be investigated before interventions to reduce sick leave can be designed. This cross-sectional study compares employees with asthma and chronic obstructive pulmonary disease (COPD) with and without sick leave. METHODS: One hundred and eighteen participants with asthma and 71 with COPD underwent a lung function test [one-second forced expiratory volume (FEV1), forced vital capacity (FVC)] and completed questionnaires on health complaints, work characteristics, demographic and psychosocial variables, and self-reported sick leave in the past 12 months. Backward multivariate logistic regression analyses, with sick leave (no/any) as dependent variable, were conducted for asthma, COPD, and the total group. RESULTS: Lung function measures were not significantly associated with sick leave in any group (P > 0.05). For asthma, psychosocial variables (spending all energy at work, OR 0.7) and health complaints (frequency of dyspnoea, OR 0.4 and breathing problems such as coughing, wheezing, OR 1.1) were associated with sick leave. In the COPD group, age (OR 0.9) was the only significant variable to be maintained in the model. In the total group, work characteristics (adjustment in work pace, OR 3.3), age (OR 0.9) and spending all energy at work (OR 0.7) were maintained in the final model. CONCLUSION: Severity of the disease, as measured by lung function, is not a determinant of sick leave in asthma and COPD. Different processes play a role in asthma and COPD. Interventions for reducing sick leave should aim more at psychosocial factors than at treating the severity of the disease.

Adult↗
PubMed2004

Probability and determinants of relapse after discontinuation of inhaled corticosteroids in patients with COPD treated in general practice.

OBJECTIVE: The objective of the study was to assess the probability, and explore determinants of adverse respiratory outcome after discontinuation of inhaled corticosteroid (ICS) treatment in subjects with chronic obstructive pulmonary disease (COPD) diagnosed and treated in general practice. DESIGN: Prospective unblinded ICS withdrawal study. SUBJECTS: 201 ICS treated COPD patients with various degrees of airflow limitation from 45 Dutch general practices. MAIN OUTCOME MEASURES: Probability of and time to exacerbation or unremitting worsening of respiratory symptoms after ICS discontinuation. RESULTS: Mean age was 60.6 (S.D. 9.5) years, post-bronchodilator forced expiratory volume in 1s (FEV1) 65.6 (S.D. 15.7) % predicted. Overall probability of adverse respiratory outcome after ICS discontinuation was 0.37 (95% confidence interval (CI) 0.31, 0.44). Survival analysis showed that age, gender, smoking status and reversibility of airflow limitation were independent predictors of adverse respiratory outcome. For females, the adjusted hazard ratio was 2.14 (95% CI 1.31, 3.50) compared to males. For age, the hazard ratio was 1.05 (95% CI 1.02, 1.08) per year lived. CONCLUSION: Discontinuation of inhaled corticosteroids may harm patients with COPD. The probability of an adverse respiratory outcome may be higher in women, elderly patients, smokers and patients with higher bronchodilator reversibility while on inhaled steroid treatment.

Journal Article↗
PubMed2004

Assessing the quality of life of adults with chronic respiratory diseases in routine primary care: construction and first validation of the 10-Item Respiratory Illness Questionnaire-monitoring 10 (RIQ-MON10).

BACKGROUND: As doctors' judgements about the burden of a disease often differ from patients' own assessments a manageable method to incorporate the latter into routine care might support patient-centered decision-making. For this purpose we shortened the 55-Item Quality of Life for Respiratory Illness Questionnaire (QoL-RIQ). METHODS: Secondary analyses of the data of 3 controlled studies (n = 328, 502 and 555). PROCEDURES: inter-item correlations, scale distributions, Cronbach's alpha and factor analysis. Dyspnoea, forced expiratory volume in 1 s (FEV1), COOP/WONCA charts, the Medical Research Council-ECCS symptoms questionnaire and the MOS-SF 36 served as criteria to test validity and responsiveness. RESULTS: Item-reduction resulted in a 10-item short form (alpha's 0.87-0.90), consisting of 2 5-item factors: (1) physical and emotional complaints and (2) physical and social limitations. The correlations of the short form with dyspnoea (r from 0.57 to 0.60), the generic health status instruments (r from 0.39 to 0.59) and lung function (r from 0.10 to 0.15) fulfilled the criteria. FURTHER RESULTS: a clinical relevant score difference (> 0.5) between upper and lower quartiles of the convergent instruments, an intraclass correlation between repeated scores in a stable group of 0.82 and a standardised response mean of 0.86 in an improved group of patients. CONCLUSIONS: The short form (RIQ-MON10) maintained the psychometric properties of the original instrument and is promising for assessing quality of life (QoL) during routine primary care visits.

Asthma↗
PubMed2004

Compliance of asthmatic families with a primary prevention programme of asthma and effectiveness of measures to reduce inhalant allergens--a randomized trial.

BACKGROUND: Compliance to and the effect of pre- and post-natal exposure reduction measures to prevent asthma in high-risk children from asthmatic families were studied. METHOD: Families were randomized to a special care group (n=222) and a control group (n=221). Educational advice on measures to reduce their newborn's exposure to allergens and smoke was provided to the special care group during three visits (two pre-natal and one post-natal). The control group (n=221) received usual care. RESULT: After the intervention, the special care group differed significantly (P<0.01) from the usual care group in: use of anti-mite encasings (parental: 88% vs. 14%; baby: 98% vs. 10%); keeping pets outside (51% vs. 19%); combined breast- and hypoallergenic formula feeding (55% vs. 22%); first solids postponement until after the sixth month (71% vs. 28%); maternal post-natal smoking (52% vs. 28%). Little or no compliance was found for other sanitary measures (cleaning habits, providing a smooth floor covering, ventilation/airing, pet removal), exclusive breastfeeding, pre-natal smoking and partner smoking. In spite of pre-existent low allergen levels in both groups, there was a significant reduction of mite, cat, and dog allergens on the mattresses and mite and cat allergens in the living room in the special care group and were significantly lower compared with the usual care group after 1 year. CONCLUSION: High compliance was found for the use of anti-mite encasings; substantial compliance for using hypoallergenic formula, solid food postponement, keeping pets outside and reported post-natal maternal smoking. There was no compliance for sanitary measures and the reduction of maternal pre-natal passive smoking. Mite and pet allergens on mattresses were strongly reduced by anti-mite encasings.

Air Pollutants↗
PubMed2004

Risk factors for development of impaired renal function in Type 2 diabetes mellitus patients in primary care.

AIMS: To evaluate risk factors for the development of an impaired renal function, defined as a glomerular filtration rate (GFR) by Cockcroft-Gault formula < 50.5 ml/min, in primary care patients with Type 2 diabetes mellitus. METHODS: A case-control study of Type 2 diabetes mellitus patients with impaired renal function and age, sex and practice matched controls with Type 2 diabetes mellitus without impaired renal function in 10 Dutch family practices performing the Nijmegen Monitoring Project. Main outcome measure was the independent risk factors of impaired renal function. RESULTS: Eighty-seven individuals with impaired renal function were identified. The point prevalence of impaired renal function in the sample population on 31 March 2001 was 87/873 (10.0%; 95% confidence interval 7.0-15.1%). Of 87 cases, 23 (26.5%; 17.3-30.9%) were found to have impaired renal function at diagnosis. Conditional multiple logistic regression analysis revealed the following independent risk factors for the development of impaired renal function: duration of diabetes > or = 8 years (adjusted odds ratio 5.6 (2.5-12.5); P < 0.001), glomerular filtration rate by Cockcroft-Gault formula 50.5-80.5 ml/min at diagnosis [3.5 (1.5-8.1); P < 0.01] and existing macrovascular complications at diagnosis [2.6 (1.1-6.3); P < 0.01]. CONCLUSION: Duration of diabetes > or = 8 years, mild renal impairment at the time of diagnosis and existing macrovascular complications at the time of diagnosis are independent risk factors for the development of impaired renal function in white patients with Type 2 diabetes mellitus.

Aged↗
PubMed2004

Treating urinary incontinence in the elderly--conservative therapies that work: a systematic review.

OBJECTIVE: To evaluate the effectiveness of conservative treatment in the community-based elderly (aged > or = 55 years) with stress, urge, and mixed urinary incontinence. DESIGN: Systematic review of before-after studies or randomized controlled trials on the effect of exercise and drug therapy in urinary incontinence. MAIN OUTCOMES MEASURED: Reduction of urinary accidents, patient's perception, cystometric measurement, perineometry, and side effects. SEARCH STRATEGY: MEDLINE (1966-2001), EMBASE (1986-2001), Science Citation Index (1988-2001), The Cochrane Library, and PiCarta were searched. RESULTS Four before-after studies and 4 randomized controlled trials were identified. Drug therapy alone: no study of sufficient quality. Drug therapy compared with behavioral therapy, 3 studies: bladder-sphincter biofeedback reduced urinary accidents in cases of urge or mixed incontinence by 80.7%, significantly better than oxybutynin (68.5%) or placebo (39.4%). Adding drug to behavioral treatment or behavioral to drug treatment also resulted in significant reduction in urodynamic urge incontinence (57.5%-88.5% vs 72.7-84.3%). Pelvic floor exercises alone reduced urinary accidents by 48% (compared with 53% for phenylpropanolamine) in patients with mixed or stress incontinence. Behavioral therapy, 5 studies: bladder-sphincter biofeedback in case of urge or mixed incontinence, bladder training in case of urge incontinence and pelvic floor exercises in case of stress incontinence reduced the urinary accidents with 68% to 94%. CONCLUSION: There are only a few studies of sufficient methodological quality on the effect of conservative treatment of urinary incontinence in the elderly. Behavioral therapy reduced urinary accidents; the effect of drug therapy is unclear. We recommend behavioral therapy as first choice.

Aged↗
PubMed2003

[The contribution of clinical research to improved patient care].

In a simplistic view, clinicians eagerly await the publication of new research results which they can incorporate into their patient care. However, the transfer of research findings into patient care is complex and it is not always possible to detect the effects of individual studies in improved diagnostic and therapeutic routines. Consequently, the relevance of clinical research is undervalued. There are several examples from across the field of medicine and surgery, which illustrate the importance of clinical studies for the quality of patient care. Clinical research must be closely related to clinical care to ensure that the research aims formulated reflect clinical dilemmas within the setting of patient care. Yet, it is even more important to understand the impact which the participation of physicians and their patients in studies has on the quality of care provided. The standardisation of diagnostic and therapeutic procedures in the preparation of clinical studies may yield an effect on the health status of patients; this might be more substantial than the effect of the actual intervention studied. Clinicians and researchers should acknowledge the importance of medical science for the quality of patient care.

Biomedical Research↗
PubMed2003

[Quality assessment of medical-scientific research: in the future it should also be assessed on the basis of social impact].

Clinical research is the basis for the improvement of clinical care, yet assessments of the quality of research output in terms of the consequences for patient care are seldom acknowledged. However, contributions to guidelines, educational programmes and other products for clinicians indicate the clinical relevance of research and researchers. A recent report from the Royal Netherlands Academy of Arts and Science (Dutch acronym: KNAW) proposes a method to measure these aspects in addition to the scientific value of the output from research programmes. The transfer of research findings into clinical practice requires an implementation process. Measurements of the societal impact of research may lead to a better understanding of this process.

Biomedical Research↗
PubMed2003

Validity of spirometric testing in a general practice population of patients with chronic obstructive pulmonary disease (COPD).

OBJECTIVE: To investigate the validity of spirometric tests performed in general practice. METHOD: A repeated within subject comparison of spirometric tests with a "gold standard" (spirometric tests performed in a pulmonary function laboratory) was performed in 388 subjects with chronic obstructive pulmonary disease (COPD) from 61 general practices and four laboratories. General practitioners and practice assistants undertook a spirometry training programme. Within subject differences in forced expiratory volume in 1 second and forced vital capacity (DeltaFEV1 and DeltaFVC) between laboratory and general practice tests were measured (practice minus laboratory value). The proportion of tests with FEV1 reproducibility <5% or <200 ml served as a quality marker. RESULTS: Mean DeltaFEV1 was 0.069 l (95% CI 0.054 to 0.084) and DeltaFVC 0.081 l (95% CI 0.053 to 0.109) in the first year evaluation, indicating consistently higher values for general practice measurements. Second year results were similar. Laboratory and general practice FEV1 values differed by up to 0.5 l, FVC values by up to 1.0 l. The proportion of non-reproducible tests was 16% for laboratory tests and 18% for general practice tests (p=0.302) in the first year, and 18% for both in the second year evaluation (p=1.000). CONCLUSIONS: Relevant spirometric indices measured by trained general practice staff were marginally but statistically significantly higher than those measured in pulmonary function laboratories. Because of the limited agreement between laboratory and general practice values, use of these measurements interchangeably should probably be avoided. With sufficient training of practice staff the current practice of performing spirometric tests in the primary care setting seems justifiable.

Adult↗
PubMed2003

Epidemiological aspects and early detection of chronic obstructive airway diseases in the elderly.

The burdens of chronic obstructive airway diseases among the elderly in Europe, and worldwide, are increasing. Although asthma is common in all ages, the main airway disease affecting the elderly is chronic obstructive pulmonary disease (COPD). The aim of this paper is to review the prevalence and incidence of COPD on the basis of population studies. As the prevalence estimates of asthma are probably well known, only the incidence and remission of asthma will be discussed. The underdiagnosis of obstructive airway diseases is huge. A Dutch programme for early detection of obstructive airway disease among the elderly has, thus, been included in the presentation. A prerequisite for fighting COPD is to acquire data on illnesses and death. COPD has only recently been defined by cut-off points of spirometric outcomes, which is why measures of the prevalence of COPD have been distorted by use of a large number of different diagnostic terms and lung function criteria. The prevalence of clinically-relevant COPD has been estimated in several community studies to 4-6% in adult population samples, with a considerable increase by age, particularly among smokers. The incidence of COPD not only increases heavily with age and smoking, but also occupational exposure to dust, gas and damp. Precise estimates of the incidence of COPD or spirometric airflow limitation are not available. Demographic changes will result in a further substantial increase of chronic obstructive airway disorders, mainly chronic obstructive pulmonary disease, among the elderly. The increasing burden of chronic obstructive pulmonary disease has to come to the awareness of the public, governments, health authorities, and industry.

Aged↗
PubMed2003

Referral and consultation in asthma and COPD: an exploration of pulmonologists' views.

BACKGROUND: The burden of asthma and chronic obstructive pulmonary disease (COPD) on national healthcare systems is expected to increase substantially in future years. Referral guidelines for general practitioners (GPs) and pulmonologists may lead to more efficient use of healthcare facilities. We explored the prevailing views of pulmonologists regarding referral and once-only consultation in asthma and COPD, and compared these views with recently published transmural referral guidelines for GPs and pulmonologists. METHODS: Cross-sectional multiple case study. Twenty-nine Dutch pulmonologists working at non-university hospitals or specialised chest clinics participated in group discussion sessions. RESULTS: The outcome of the discussions and recently published referral guidelines for GPs and pulmonologists showed considerable similarity, but also some marked discrepancies. During the discussions, the main points of disagreement among the pulmonologists were: 1) should GPs or pulmonologists add long-acting beta2-agonists to asthma treatment regimens; 2) should the current cut-off point 'predicted FEV1 <50%' for referral of COPD patients be increased to 60 or 70%; and 3) should an annual exacerbation rate of two episodes a year be used as an undifferentiated referral criterion for COPD patients? For asthma, proposed back-referral (i.e. from pulmonologist to GP) criteria rested on: required dose of inhaled steroids, persistent need for long-acting beta2-agonists, duration of clinical stability and persistence of airway obstruction. Back-referral criteria for COPD rested on age, blood-gas abnormalities and ventilatory limitations. Primary care monitoring facilities and 'shared-care' constructions were considered to be facilitating conditions for back-referral. CONCLUSIONS: This explorative study provided insights into how pulmonologists visualise a rational referral policy for patients with asthma or COPD. These insights can be taken into consideration in future revisions of referral and back-referral guidelines for GPs and pulmonologists.

Adult↗
PubMed2002

[An analysis of cases of missed acute appendicitis: for the time being there is no basis for a better policy].

Case reports of patients with acute appendicitis that was not recognised in time highlight the probability and the implications of significant complications. Early surgical treatment is dependent on early diagnosis, and this is usually the domain of general practice. With regard to the missed cases, it is important to see them in proper perspective: appendicitis is present in only a minority of all presentations of abdominal pain. General practitioners should refer 'liberally' in case of even minor signs or symptoms, so that appendicitis will be missed only in cases with a highly atypical presentation. It is important to realise that this happens, but it is not possible to draw conclusions from it that can serve as a guide to routine practice, as referral of all presentations of abdominal pain would be undesirable. There is a need to test the added value of diagnostic procedures like CRP and echography. However, until there is evidence that this could change the practice in atypical cases, practitioners can do no better than to reflect upon their faults.

Abdominal Pain↗
PubMed2002

Different study criteria affect the prevalence of benzodiazepine use.

BACKGROUND: Different prevalences of benzodiazepine (BZ) use are described in the literature. The present study assessed the effects of employing various definitions of BZ use and various observation periods on the prevalence rate of BZ use in an open population aged 18-74 years. METHOD: In a literature review, prevalence studies were systematically compared. In a second stage, a descriptive cross-sectional multipractice study was analysed using 48,046 prescriptions of BZ in the past year given to a population of 80,315 patients at 31 general practices in the Nijmegen Health Area. From this database, prevalence rates were calculated applying different definitions of BZ use and different observation periods. RESULTS: In the literature, prevalence rates varied between 2.2 and 17.6%. There was wide variation in definitions of BZ use and observation period. In our prescription database, depending on the definitions of BZ use and observation period, prevalence rates ranged from 0.2% to 8.9%. The ratio of female:male (2:1) remained constant irrespective of the prevalence rate. Age distribution varied according to the duration of use: among long-term BZ users, approximately 80% were older than 45 years; among short-term BZ users, approximately 55% were older than 45 years. CONCLUSIONS: The wide variation in prevalence rates of BZ use reported in the literature can largely be explained by differences in definitions of BZ use and observation period. This affected the distribution of some BZ-use-related variables such as age. For reliable comparisons of BZ use, standardisation of the definition of BZ use is required. A proposal for standardising methodology is presented.

Adolescent↗
PubMed2002

Lower urinary tract symptoms: social influence is more important than symptoms in seeking medical care.

OBJECTIVE: To determine associations among lower urinary tract symptoms (LUTS), symptom severity, subjective beliefs and social influences when seeking primary medical care in men aged > or = 50 years. SUBJECTS AND METHODS: A population-based survey was conducted among 5052 men aged > or = 50 years, using patient registers of 22 general practitioners (GPs) in the Netherlands from November 1999 to May 2000. The questionnaire contained items concerning age, educational level, International Prostate Symptom Score (IPSS), bothersome score (BS), and questions from the Health Belief Model on attitude and social influences. The study population comprised men with an IPSS openface> 7. The odds ratios (ORs) corrected for the IPSS were calculated. RESULTS: In all, 3544 questionnaires (70.2%) were returned. Two groups of men with an IPSS openface> 7 were compared: those who consulted their GP in the previous 2 years because of voiding problems (268 cases) and the controls (272) who did not visit a GP for these symptoms. Cases more often thought a physician could improve their condition (OR 2.85), appeared to be more often advised by others to seek medical care (OR 6.36) and thought more often that this advice influenced their decision (OR 13.95). They also had more frequently received information from the media (OR 2.66) which affected their attendance (OR 12.52). In a multiple regression analysis, advice from others or information from the media were stronger predictors of seeking care than the influence of symptoms on daily life, the IPSS or the BS. CONCLUSION: Social influences, i.e. advice from others or the media, were more important factors in the decision to seek medical care than symptom severity.

Aged↗
PubMed2002

Is the increase in bronchial responsiveness or FEV1 shortly after cessation of beta2-agonists reflecting a real deterioration of the disease in allergic asthmatic patients? A comparison between short-acting and long-acting beta2-agonists.

Regular use of beta2-agonists might result in increased bronchial hyper-responsiveness (BHR) and decreased forced expiratory volume in 1 sec (FEV1). It has been suggested that these possible detrimental effects are not a real deterioration of the disease, but that it might be only a transient (rebound) effect shortly after discontinuing this regular use. Moreover, these effects are thought to occur especially during short-acting and not during long-acting beta2-agonists use. The aim of this study was to invest gate whether a rebound effect (a pharmacological deterioration effect diminishing after several hours) in FEV1 and PC20 (concentration of histamine causing a 20% fall in FEV1 with regard to baseline) occurred after cessation of regular use of beta2-agonists, and whether this occurred both after short-acting and long-acting beta2-agonists. Allergic asthmatic patients (n = 134) were randomly allocated to the use of a short-acting (salbutamol), a long-acting beta2-agonist (formoterol) or placebo for 12 weeks (double-blind, double-dummy). No other asthma medication was allowed, including inhaled corticosteroids. At the start and every 4 weeks later FEV and PC20 were measured, each time at least 12 h after the last doses of study medication, which is in the possible rebound period. To investigate whether a (transient) rebound effect occurred, parameters were additionally measured at least 72 h later after discontinuation of the study medication. After 12 weeks of short-acting beta2-agonist use, a drop was seen in FEV1 from 85.6 (+/- 2.21)% predicted to 78.8 (+/- 2.9)% predicted, measured 15 h (median) after the last doses of medication. This was significantly different compared to placebo. When measured 168 h (median) later FEV1 recovered to 85.5 (+/- 2.4)% predicted, comparable to baseline. PC20 decreased with -1.17 (+/- 0.44) doubling dose after 12 weeks of short-acting beta2-agonist use, measured 15 h after the last doses of medication, which was significantly different compared to placebo. However, 168 h later PC20 recovered slightly with +0.55 (+/- 0.34) doubling dose, but this value was still lower compared to placebo. In contrast, during long-acting beta2-agonist and placebo use no significant changes were seen. In conclusion, the use of short-acting beta2-agonists resulted in a transient (rebound) effect in FEV while the effects on PC20 may point to a real deterioration of the disease. Long-acting beta2-agonist and placebo use showed no changes. We conclude that a mono-therapy of short-acting and not of long-acting beta2-agonists might have deleterious effects in asthma.

Adrenergic beta-Agonists↗
PubMed2002

Cardiovascular risk factors and disease in general practice: results of the Nijmegen Cohort Study.

The relationship between risk factors and cardiovascular disease (CVD) was determined using data from the Nijmegen Cohort study, an 18-year prospective study. In 1977, cardiovascular risk factors were measured in 7092 Caucasian males and females from six general practices: age, smoking, serum cholesterol, blood pressure, body mass index and a family history of CVD were related to subsequent CVD mortality and morbidity. Most patients had more than one risk factor in particular among men. A significant relationship between risk factors and CVD was demonstrated. In men, a relative risk (RR) of 1.8 was found for both high blood pressure and smokers. A positive family history yielded a RR of 1.8. The risk increased gradually with the number of risk factors; 38% of the group with all risk factors suffered a CVD within 18 years. In women, comparable RRs were found but the low absolute risk of CVD should indicate against the treatment of cardiovascular risk factors.

Adult↗