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F Buntinx

Publications and source records attributed to F Buntinx.

36 records · Page 2Linked to original sources
PubMed1995

Long-term effect of feedback and peer comparison on the sampling quality of cervical smears--a randomized controlled trial.

In a randomized controlled trial the effect of feedback and peer review directed at the sample-taking doctor (n = 179) on the sampling quality of cervical smears (n = 21,240) was studied. This paper reports the impact 6 and 12 months after the end of the intervention. Monthly feedback with peer comparison was related to a net improvement in the proportion of cervical smears without endocervical cells during the intervention period, as well as during a follow-up period lasting until 15 months after the end of the intervention. This improvement seemed to be related to a minimum of 50 or even 100 smears performed each year and was therefore not confirmed on clustered data analysis. There is a strong suggestion that the intervention also related to an increase of the number of smears showing cytological pathology, although this study lacked sufficient power to test this hypothesis.

Cluster Analysis↗
PubMed1995

Composition of cervical smears in patients with and without a cervical ectropion.

AIMS: To test the hypothesis that absence of squamous cells in cervical smears obtained by an endocervical sampling technique is more prominent in patients with a cervical ectropion. METHODS: Prospective study exploring the relation between the composition of cervical smears obtained using an endocervical cotton swab in patients with (n = 188) and without (n = 341) a cervical ectropion. Subjects were 529 consecutive patients from whom a cervical smear was prepared at a university gynaecological clinic. RESULTS: In 7% of the endocervical samples no squamous cells were found. There was no correlation, however, between the presence or the size of an ectropion and the absence of squamous cells in those samples. CONCLUSIONS: It was confirmed that endocervical sampling alone is insufficient to obtain good quality cervical smears. The presence of an ectropion proved to be an unreliable predictor of the absence of squamous cells.

Cervix Uteri↗
PubMed1995

The trough-to-peak ratio as an instrument to evaluate antihypertensive drugs. The APTH Investigators. Ambulatory Blood Pressure and Treatment of Hypertension Trial.

The U.S. Food and Drug Administration designed the trough-to-peak ratio as an instrument for the evaluation of long-acting antihypertensive drugs, but the ratios are usually reported without accounting for interindividual variability. This study investigated how the trough-to-peak ratio would be affected by interindividual and intraindividual variability and by smoothing of the diurnal blood pressure profiles. The ambulatory blood pressure was recorded on placebo in 143 hypertensive patients (diastolic pressure on conventional measurement > 95 mm Hg). After 2 months, the recordings were repeated on 10 mg (n = 66) or 20 mg (n = 77) lisinopril given once daily between 7 and 11 PM. The baseline-adjusted trough-to-peak ratios were determined from diurnal blood pressure profiles with 1-hour precision. Lisinopril reduced (+/- SD) the 24-hour pressure by 16 +/- 17 mm Hg for systolic and 10 +/- 10 mm Hg for diastolic (P < .001). According to the usual approach, disregarding interindividual variability, the trough-to-peak ratio was 0.72 for systolic pressure and 0.67 for diastolic pressure. In the 143 patients the ratios were not normally distributed. They were the same on both lisinopril doses. When interindividual variability was accounted for, the median trough-to-peak ratio was 0.34 (P5 to P95 interval, -0.46 to 0.87) for systolic pressure and 0.26 (-0.44 to 0.84) for diastolic pressure. In 66 patients examined twice on 10 mg lisinopril at a median interval of 32 days, the trough-to-peak ratios were characterized by large intraindividual variability.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Role of the family practitioner in the management of patients following a myocardial infarct].

OBJECTIVE: Determining the role of the general practitioner (GP) in the management of the postinfarction patient, the factors that influence this role, and the relation between GP and cardiologist. DESIGN: Descriptive. SETTING: Registration Network of Family Practice (RNF) of the University of Limburg, the Netherlands. METHOD: Data were obtained from a sample of 284 patients from 30 GPs, all participating in the RNF. The GPs completed a questionnaire about their own patients while the data concerning the cardiac state of the patients were obtained from their problem lists. RESULTS: Postinfarction care was given in only 50% of the patients. Relatively more patients with a more severe cardiac condition were under regular medical follow-up than those with a less severe cardiac condition. However, the severity of the disease had no effect on the specialty of the doctor performing the follow-up (GP or cardiologist), nor had the time expired after the myocardial infarction. In almost 50% of the cases the GPs found continuation of the follow-up by the cardiologist not necessary, in 25% of the cases they were not satisfied with the complementary roles of both disciplines. CONCLUSION: Postinfarction care by the GPs was not uniform. They need guidelines for the management of such patients, based on the patient's risk profile. There is a need for better coordination between GP and cardiologist.

Aftercare↗
PubMed1994

How do general practitioners diagnose dementia?

By means of a qualitative study, we set out to generate hypotheses about the way general practitioners (GPs) diagnosed dementia. We looked for triggers for the diagnosis of dementia. Ten GPs were interviewed about four dementia cases taken from their own practices. GPs are more concerned with treatment than with the diagnosis of dementia as such, as diagnosis is performed in relation to treatment. The most important aid was the evolution of the clinical tables based on the information of caregivers. Important triggers were changes of activities of daily life function, behaviour and cognition. Acute illness and loss of the key caregiver were relevatory moments. Recommendations are made for the improvement of the diagnostic abilities of GPs.

Activities of Daily Living↗
PubMed1994

The effect of different sampling devices on the presence of endocervical cells in cervical smears. A systematic literature review.

A literature search examined 39 reports on the relationship between the absence of endocervical cells in a cervical smear and the sampling technique used. Using (pooled) ratios we compared the results for different pairs of sampling devices, thereby controlling for the design of each study when appropriate. The Cytobrush appears the most efficient sampling method with regard to the presence of endocervical cells. Combining the results of this review with the results of a previous meta-analysis on the effect of the sampling technique on the detection of pathology, the combined spatula and Cytobrush technique seems to be the best sampling method.

Cervix Uteri↗
PubMed1993

Interobserver variation in the assessment of the sampling quality of cervical smears.

In order to assess the interobserver variation among cytological assistants in evaluating the sampling quality of cervical smears, all four laboratory assistants from one cytological department examined the same set of 71 smears. They assessed the presence of endocervical cells, the quality of fixation, the number of cells and the undesirable presence of clumps of cells. The interobserver agreement, uncorrected for chance, varied from 73 to 93% for the presence of endocervical cells and from 86 to 100% for the three other criteria. For the presence of endocervical cells, the kappa values, a measure for the interobserver agreement corrected for chance, varied from 42 to 84%. This is a reasonable outcome. For the three other criteria many kappa values were zero or uncalculable. The interobserver agreement in evaluating the sampling quality of cervical smears is reasonable to good, but not perfect. Prudence in the interpretation of quality data is warranted.

Female↗
PubMed1993

The influence of a desk-top analyser on the number of laboratory tests used in daily general practice. A randomized controlled trial.

This study evaluated the influence of a desk-top analyser, used in general practice, on the mean number of blood tests per contact, prescribed or analysed by general practitioners. A randomized controlled trial was used. The mean number of blood tests per contact requested by two groups of GPs, before and after the introduction of a Reflotron in the intervention group was compared. Practitioners were assigned to the control group or to the intervention group by stratified randomization. Flemish GPs, known by the Flemish Institute of General Practice as interested in research were enrolled into the study. There were two registration periods of 8 weeks each. The weekly number of doctor-patient contacts and all requested or performed blood tests for each patient were registered. During the second period the members of the intervention group were asked to use the Reflotron, following their own judgement, and to register the total number of tests per contact, performed with it, on a special form. In the Reflotron group there was a slight increase in the median of the relative differences between the intervention and the base-line period (3%). In the control group the median of the relative differences decreased (-7%). The difference between both groups was not statistically significant (P = 0.17). In both groups the size and direction of the relative differences of the individual practices were very different. No statistically significant differences were found in any of the subgroups.

Blood Chemical Analysis↗
PubMed1993

Influencing diagnostic and preventive performance in ambulatory care by feedback and reminders. A review.

The number of good quality studies on the effect of feedback and reminders on diagnostic and preventive activities in ambulant practice is still low. The interventions and procedures studied differ widely, and the reporting of the results is insufficiently precise. This makes comparison difficult and quantitative pooling impossible. Nevertheless, the literature supports the contention that feedback reduces the use of diagnostic tests and the costs thereby engendered. It also discloses a positive effect of feedback on the adherence of medical practice to guidelines or standards. In this respect, the effect of reminders seems to exceed that of classical methods of feedback. There is still a need for research on the effect of feedback, reminders and other instruments for quality assurance on various aspects of medical performance in different settings.

Ambulatory Care↗
PubMed1993

Does feedback improve the quality of cervical smears? A randomized controlled trial.

In a randomized controlled trial three methods of feedback of increasing intensity, directed at 183 doctors taking cervical smears, were compared with respect to their effects on the sampling quality of smears. Overall, feedback was found to have no influence on quality criteria in the crude data analysis. However, a significantly larger decrease in the percentage of smears lacking endocervical cells was found in the groups receiving monthly overviews of their results with peer comparison, when compared with the groups not receiving this type of feedback (odds ratio 0.75). Moreover, feedback appeared to have a clear effect on the presence of endocervical cells among doctors submitting a substantial number of smears in the intervention period, as opposed to those who submitted fewer smears. A positive correlation was also observed between the increase in the group mean of the proportions of smears containing pathological cells and the intensity of the feedback. However, this increase did not reach statistical significance. This study suggests that monthly feedback with peer comparison may have a positive relationship with some aspects of quality improvement in cervical screening.

Adult↗
PubMed1992

Evaluating patients with chest pain using classification and regression trees.

We collected data on 320 patients complaining to their general practitioner of a new episode of chest pain, discomfort or oppression. Relationships were examined between initial signs and symptoms and a follow-up diagnosis after a period of 2 weeks to 2 months. The data were analysed with CART, a statistical decision theory software package. In our first run, the number of misclassifications by CART was 56%. After regrouping of the data and diagnostic categories, there were 37% misclassifications. The most discriminating variable turned out to be pain on palpation. When comparing each of five diagnostic groups to all others, we found a positive predictive value of 27% for gastrointestinal diseases, 72% for cardiovascular disorders, 69% for respiratory diseases, 58% for psychopathology and 73% for chest wall pathology. The CART methodology needs further investigation and testing before any clinical application will be possible in general practice.

Chest Pain↗
PubMed1992

[Meta-analysis: a structured bibliographic protocol].

Meta-analysis is a way of reviewing literature in a structured and systematic format. A formalized protocol for selection of the reviewed papers and a qualitative as well as quantitative evaluation are essential. Mathematical pooling of the results of the individual studies can be part of the process. A number of pitfalls are possible. However, when performed in a correct way and evaluated critically by the reader, a meta-analysis can add consistently to the medical knowledge concerning a specific subject.

Information Services↗
PubMed1992

Reactions of doctors to various forms of feedback designed to improve the sampling quality of cervical smears.

Three different forms of feedback designed to improve the sampling quality of cervical smears were tested in a randomized controlled trial among 179 physicians. The reactions of the doctors to the various interventions are reported as they appeared from their answers in a questionnaire. The influence of the interventions on the employed sampling technique is described on the basis of their answers to a telephone inquiry. The inclusion in laboratory protocols of an evaluation of the sampling quality of the submitted smears was largely appreciated, as was specific advice offered on indication. Monthly overviews comparing the performance of the individual doctor to that of his peers were esteemed by three out of four. Further information, help or training was requested more frequently than average by physicians obtaining inadequately sampled smears relatively often. The number of doctors using the combined spatula and Cytobrush method as sampling technique doubled during the study period.

Feedback↗
PubMed1991

Geographical variations in the sampling quality of cervical smears.

It is generally accepted that cervical smears are adequately sampled when they contain endocervical and/or metaplastic cells. An extensive literature search via MEDLINE and FAMLI for papers on cervical smears yielded 33 articles providing explicit information both on the country where the study was executed and on the relationship between the adequate sampling of smears and the sampling method used. The correlation between the geographic origin of cervical smears and the proportion of those smears that were adequately sampled was examined. The results were controlled for the sampling method. It was found that the proportion of adequately sampled smears reported in studies in the U.K. is exceedingly low, in contrast with the proportion reported from The Netherlands. The differences between the various countries studied are stable over different sampling methods. It is suggested that, in order to ameliorate the sampling quality of cervical smears, factors associated with the working conditions in particular regions also need be considered.

Europe↗
PubMed1991

Chest pain: an evaluation of the initial diagnosis made by 25 Flemish general practitioners.

Twenty-five general practitioners collected information on 318 contacts of patients with a new episode of chest pain, discomfort or tightness. A list of complaints, signs and symptoms were checked, together with the initial diagnosis, made by the GP immediately after the physical examination. The initial diagnosis was compared to a follow-up diagnosis. The gain in certainty was also compared. The GP made a correct initial diagnosis in 82% of patients. In 8% there was a clinically important difference, and seven of 17 episodes of oesophageal disease were missed. For their initial diagnosis, the GP scored 74% certain, 20% uncertain and no diagnosis in 6%. For the final diagnosis, these figures were 88%, 8% and 4%.

Belgium↗
PubMedDate not supplied

Comparison of Cytobrush sampling, spatula sampling and combined Cytobrush-spatula sampling of the uterine cervix.

Since the introduction of the Cytobrush for sampling the uterine cervix, some practitioners have ceased taking a concomitant cervical scraping using a spatula. To examine whether Cytobrush sampling alone is adequate for the diagnosis of cervical lesions, the Cytobrush and spatula samples in 444 smears (most with original diagnoses of at least mild dysplasia) were analyzed separately for the presence of diagnostic cells, endocervical cells and squamous cells. Of the 412 smears showing pathologic findings (mild to severe dysplasia or worse), diagnostic cells were present in 400 Cytobrush samples and in 369 spatula samples; the combination of both samples thus gave a 3% gain in correct diagnoses as compared to use of the Cytobrush samples alone. Another 18 smears would have been underdiagnosed based only on the Cytobrush samples. Endocervical cells were present in 95.3% of the Cytobrush samples and 83.8% of the spatula samples; squamous cells were present in 93.9% of the Cytobrush samples and 96.8% of the spatula samples. Analysis confirmed that it is important that the smear should contain both endocervical and squamous cells. A positive relationship between the absence of squamous cells in the Cytobrush sample and the probability of a false-negative assessment was suggested. It thus seems inadvisable to replace the combination sampling method by Cytobrush sampling alone, which may lead to a false-negative diagnosis.

Adult↗