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Biomedical subjects

D Post

Publications and source records attributed to D Post.

At least 37 records · Page 2Linked to original sources
PubMed1996

Regulation and characterization of the interferon-alpha present in patients with advanced human immunodeficiency virus type 1 disease.

To examine a possible association between plasma viremia and interferon-alpha (IFN-alpha) in patients with the acquired immunodeficiency syndrome (AIDS), we performed IFN plasma immunoadsorption by apheresis (IFN-alpha apheresis) in four volunteers with AIDS who had sustained levels of endogenous plasma IFN-alpha. IFN-alpha apheresis with two plasma volume exchanges was performed daily for 5 days. Clinical signs and symptoms and hematologic, virologic, and immunologic parameters were monitored. Two subjects developed anemia from phlebotomy, and one had a catheter++-associated bacteremia. The IFN-alpha apheresis was effective only in transiently removing IFN-alpha: depletion of IFN-alpha led only to its rapid reconstitution. Cell-associated HIV-1 was unchanged, but three of four subjects had a modest decrease in culturable plasma virus burden following the procedures. The recovery of in vivo HIV-1-related IFN-alpha by apheresis allowed its biologic and biochemical characterization. The HIV-1 IFN-alpha showed characteristics on ELISA, western blot, and biologic assays similar to two subspecies of the natural protein. The natural, recombinant, and HIV-1-induced IFN-alpha s demonstrated nearly identical antiviral activities. The HIV-1 IFN-alpha eluted from the column was not acid labile. The inability of large amounts of plasma IFN-alpha found in some patients with AIDS to affect viral burden likely reflects properties of the virus or of host factors independent of IFN-alpha.

Acquired Immunodeficiency Syndrome↗
PubMed1995

[What determines waiting time for cataract surgery, knee arthroscopy and total hip arthroplasty and how satisfied are the patients?].

OBJECTIVE: To gain an insight into the waiting periods for cataract, arthroscopic knee and total hip operations and the patients' opinion on this subject. DESIGN: Retrospective study. SETTING: The district of Groningen, the Netherlands. METHOD: A study population of 300 national health insurants who underwent a cataract operation (100), an arthroscopic knee operation (100) or a total hip operation (100) in 1992 and 50 private insurants who underwent a cataract operation in 1992, was obtained by a select sampling. By a structured questionnaire, information about basic variables (age, gender, education, occupation, perceived urgency and form of insurance), waiting periods and opinions on the waiting periods was gathered. RESULTS: The waiting periods between the specialist consultation and the operation were 5.2 and 7 months for eye, knee and hip patients respectively. The waiting period per hospital varied from 4-7 months for an eye operation, 1-4 months for a knee operation and 2.5-12 months for a hip operation. The waiting period was not affected by basic variables, except the waiting period for hip operation which benefited from a high urgency declaration by the specialist. 60% of the eye patients, 45% of the knee patients and 47% of the hip patients were satisfied about the waiting period. 15% of all patients were dissatisfied about it. CONCLUSION: Waiting periods for operations in this study were not determined by patient-specific basic variables, varied strongly between hospitals and did not cause discontent among the majority of the patients, despite durations of mostly several months.

Adult↗
PubMed1995

[Outpatient preoperative examination by the anesthesiologist. I. Fewer procedures and preoperative hospital days].

OBJECTIVE: To study the effect of the reorganisation of the preoperative screening on the volume of laboratory and function tests, and on preoperative hospital days. SETTING: General Hospital De Weezenlanden, Zwolle, The Netherlands. DESIGN: Retrospective study. METHOD: In The Netherlands the surgeon is responsible for the preoperative screening (anamnesis and general examination). In 1992 the preoperative screening was reorganised and it was carried out in the outpatient department under the responsibility of the anaesthesiologist. Laboratory and function tests were only performed if indicated. Data on 3122 patients, operated in 1991, were compared with the data on 3258 patients from 1992. Multiple regression analysis and chi-square test were used. RESULTS: The proportions of the patients subjected to laboratory tests, ECG or a chest X-ray decreased from 90%, 55%, and 50% respectively in 1991 to 53%, 43% and 10% in 1992 (p < 0.05). Admission on the day of surgery increased from 13% in 1991 to 21% in 1992 (p < 0.01). Clinical preoperative evaluation with admission more than 1 day before surgery, decreased from 5% in 1991 to 4% in 1992 (p = 0.02). The mean duration of the hospital stay before the operation decreased from 0.79 day per patient in 1991 to 0.65 in 1992 (p = 0.02). CONCLUSION: If the preoperative screening is carried out by the anaesthesiologist, all the patients have the opportunity to meet the anaesthesiologist before the operation. The number of preoperative hospital days can be reduced by outpatient preoperative screening. Laboratory and function testing on only if indicated reduces the volume of the laboratory tests, ECGs and chest X-rays.

Adolescent↗
PubMed1995

[Outpatient preoperative examination by the anesthesiologist. II. Patient satisfaction].

OBJECTIVE: To determine patient satisfaction after the reorganisation of the preoperative screening. SETTING: General Hospital De Weezenlanden, Zwolle, The Netherlands. DESIGN: Retrospective patient interview. METHOD: Before the reorganisation, the preoperative screening was performed clinically under the responsibility of the consultant surgeon. Thereafter it was performed in the outpatient department by the anaesthesiologist. Patients who had had two similar operations within two and a half years, one before and one after the reorganisation, were interviewed at home regarding the different methods of preoperative screening (n = 94). RESULTS: The preoperative screening had a reassuring effect on patients. 72% considered preoperative anaesthesia information important. The number of hospital visits before the operation did not significantly increase after the screening was reorganised. There was little objection to attending the hospital for preoperative screening (12%). Most patients (60%) had no preference for the previous or the present method of screening. Patients who remembered the interview with the anaesthesiologist (56%) preferred the new method (score: 8.2 on a scale 0-10; score of the former method: 7.6; p < 0.01). A larger number of these had the opportunity to ask questions (p = 0.01) and more patients had received attention from the anaesthesiologist (p < 0.01). 75% of the patients had received sufficient preoperative anaesthesia information. 28% of the patients wanted to see the anaesthesiologist again after admission. CONCLUSIONS: Preoperative screening reassures and informs the patient. The patients who could remember the interview with the anaesthesiologist preferred the preoperative screening in the outpatient department. A considerable number of the patients wanted to see the anaesthesiologist again after admission.

Adolescent↗
PubMed1994

[Appropriate use of balloon angioplasty; a study in the Eindhoven region].

OBJECTIVE: To gain insight in the volume of PTCAs in the region of Eindhoven and in the appropriateness of the intervention. DESIGN: Descriptive. SETTING: Department of Cardiology in the Catharina Hospital at Eindhoven. METHODS: The number of PTCAs was counted in Eindhoven and surrounding area. Peer review was carried out of 50 randomly chosen patients. General practitioners were asked about their opinion of the appropriateness of the intervention in their patients. RESULTS: In the region of Eindhoven 91.5 PTCA's are done per 100,000 inhabitants yearly (the national average in 1993 in the Netherlands is 71), 38 in the rural and 133 in the urban subregions. Peer review (by two (intervention) cardiologists, three public health doctors) showed that in 82% of the cases the indication for PTCA was appropriate. According to the Working Group for Interventional Cardiology 34% of the cases were classic indications, 64% were indications in development, and 2% were wrong. In the urban region there were more indications in development than in the rural regions. The general practitioners agreed with the cardiologists about the appropriateness of the PTCAs in their patients. CONCLUSION: Although the number of PTCAs is relatively large in the Eindhoven region, the indications for the intervention were in accordance with accepted rules.

Adult↗
PubMed1994

[Determinants of medical consumption in older subjects covered by national health insurance].

OBJECTIVE: Investigating to what extent the medical consumption of persons aged 50-80 yr covered by the Dutch National Health Service is explained by their health condition and sociodemographic factors like age, gender, marital status and education. DESIGN: Questionnaire. SETTING: 15 general practices (3 in each of 5 municipalities) in the provinces Drenthe and Overijssel, the Netherlands. METHOD: A one-time prestructured health questionnaire (in writing) was sent to 1875 persons aged 50-80 yr covered by the Dutch National Health Service (125 randomly selected persons from each practice). The response was 55% (n = 1022). The objective and subjective health conditions and the sociodemographic factors were tested in relation to the medical consumption (visiting a general practitioner, a specialist, or hospitalization) with a type of regression analysis with which both direct and indirect relations with medical consumption could be calculated. RESULTS: The medical consumption was explained for 17% by the health condition, the age and the level of education of patients. Elderly, single women with little education had the highest medical consumption. This was mainly determined by the higher probability of health problems in this group. Apart from this there was an age-related increase in medical consumption. CONCLUSION: Only part of the medical consumption can be explained by the main literature determinants of medical consumption. Refinement in research can be achieved by relating the care demand to research into referral behaviour of general practitioners and specialists, which can result in supplementary knowledge on determinants of medical consumption.

Age Factors↗
PubMed1991

[Differences in health care provision between 11 ENT partnership practices in 2 health insurance catchment areas].

Medical insurance organizations possess a large amount of production data from individual health care providers and from institutions. These data give insight into the type and amount of health care delivered. The number of admissions, patient days, inpatient and outpatient procedures and three specific procedures, per 100 referred patients and per 1000 insured persons, from 1986 were compared for 11 partnerships of ENT specialists located in the regions of two medical insurance organizations. The raw data were corrected for percentage of persons aged 65 years and older, the percentage of women, the referral practice of the general practitioners in the treated patient population and the number of specialists in each partnership. The differences between the partnerships with the largest and those with the smallest number of items of service amount to a factor 2.9 (admissions per 1000 insured persons) to 6.7 (septum corrections per 1000 insured persons). After introduction of the independent variables, substantial differences still exist, the lowest factor being 1.8 (hearing improvement operations per 1000 insured persons) and the highest 5.6 (outpatient procedures per 1000 insured persons). There is hardly any difference between the groups regarding a procedure with a supposedly clear indication and two procedures with a less defined indication. Further study of the causes of these differences on the individual patient level is necessary.

Catchment Area, Health↗
PubMed1987

Identification and characterization of the Pasteurella haemolytica leukotoxin.

The identification and chromatographic characterization of the leukotoxin of Pasteurella haemolytica is described. The toxin, which has an apparent native molecular weight of greater than 400,000 as judged by gel exclusion chromatography, has a 105-kilodalton (105K) polypeptide as its major protein component. The proteolytic degradation of the 105K polypeptide could be correlated with the loss of toxin activity in aging cultures of P. haemolytica. Antisera raised against purified 105K polypeptide neutralized toxin activity. A 3.9-kilobase-pair fragment of the P. haemolytica genome cloned into a plasmid vector resulted in the production of intracellular toxin in Escherichia coli host cells. The restriction map of this clone shows significant overlap with the map of a previously reported leukotoxin clone (R. Y. C. Lo, P. E. Shewen, C. A. Strathdee, and C. N. Greer, Infect. Immun. 50:667-671, 1985). Finally, antisera raised against the 105K species labeled the P. haemolytica cell surface in a nonuniform, punctate manner.

Animals↗
PubMed1986

Acute low back pain: patients' perceptions of pain four weeks after initial diagnosis and treatment in general practice.

In a nationwide study of the treatment of acute low back pain with and without radiation in general practice in the Netherlands the subjective well-being of patients was evaluated by means of a short questionnaire sent to patients four weeks after the initial contact with their general practitioner.After this period pain had disappeared in 28% of the patients, was diminished in 47%, was unchanged in 2% and was aggravated in 4%. There was no difference in the pain score of patients with and without follow-up encounters with their general practitioner. In all instances patients with low back pain without radiation fared significantly better than those with radiation. Radiation of pain was not constant - during the four-week follow-up period it developed in 19% of the patients originally without radiation and it disappeared in 44% of the patients originally suffering radiation.

Acute Disease↗