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Biomedical subjects

H F Crebolder

Publications and source records attributed to H F Crebolder.

At least 37 records · Page 2Linked to original sources
PubMed1997

People with intellectual disability in general practice: case definition and case finding.

In a general practice database containing data on 62,000 patients, those with intellectual disability (ID) were traced. Health problems in this database were recorded according to the International Classification of Health Problems in Primary Care (ICPC) code. By using selected codes, 318 people with ID (0.65% of the study population) were found; the sample contained nearly as many false positives. Adding up the percentage of people with ID living in residential facilities, the total prevalence of people with ID was estimated as 0.82%. Documentation on the cause and level of ID was available in about half of the cases. The demographic characteristics of the people with ID were significantly different from the general population: there was a higher percentage of males and a lower percentage of people over 50 years of age among those with ID. Information about the use of home care was virtually non-existent in the general practice data. The results are compared with those of other studies. The discussion deals with reasons for complete documentation of cases with ID in general practice and the role of the general practitioner in health care supply to people with ID.

Adult↗
PubMed1996

[Home visits by community health nurses can contribute to the family practitioner's knowledge of elderly patients].

OBJECTIVE: To determine to what extent the general practitioner (GP) is aware of the health status and functioning of his elderly patients and in which areas this knowledge can be completed with the aid of community nurses. DESIGN: Cross-sectional, descriptive. SETTING: Department of General Practice. State University Limburg, Maastricht, the Netherlands. METHODS: A random sample of 59 patients aged 79 years and over, belonging to the population of a primary health care centre, were visited by community nurses. One patient was lost. The nurses inventoried the patients health complaints and their daily functioning by means of a structured questionnaire. Data from these home visits were compared with data from the same questionnaire, regarding the same patients, which the three GPs of the health centre had filled in on the basis of their medical records. RESULTS: Of the complaints recorded by the community nurses. 34% were not known to the general practitioners. This concerned mainly symptoms of depression, urinary incontinence, disabilities and handicaps of the musculoskeletal system. sleep disturbances, daily functioning and ability to cope. The main determinants of the ability to cope were impaired walking and to a lesser degree symptoms of depression. CONCLUSION: A structured interview of elderly patients by a community nurse yields substantial information about health problems.

Activities of Daily Living↗
PubMed1996

Predictors of professional and non-professional community care for care-dependent adults.

The increasing number of elderly people in most industrialized countries makes reforms in health care necessary. However, knowledge of factors that determine the use of care is scarce. The study described in this article focuses on predictors of the diversity of professional and non-professional care used by care-dependent adults who live in the community. A group of 177 care-dependent adults was identified by means of a large scale telephone survey in the Dutch community of Tegelen. Potential predictors of the diversity of professional and non-professional care were derived from Andersen's Behavioral Model of Health Services [4,5] and Litwak's Task Specifity Model [12]. Both models proved to be valuable for the explanation of variance in the diversity of care. Potential predictors derived from the two models could account for 21% of the variance for total care, 25% of the variance for professional care, and 34% of the variance for non-professional care.

Caregivers↗
PubMed1996

Anticipatory care and the role of Dutch general practice in health promotion--a critical reflection.

The Dutch GP is in a unique (potential) position within the health care system with regard to clinical health promotion. An essential feature is the integration in the regular consultation. The concept of anticipatory care seems fit to understand this integration. Because of the GP's (anticipatory) knowledge of the patient's medical history, lifestyle, risk factors, living conditions, health perceptions and family context, he has the opportunity to include during the consultation, aspects of health promotion and disease prevention. The production of evidence-based guidelines by the Dutch College of General Practitioners greatly enhances the integration of health promotion within the consultation. Strategies for the implementation are needed on three different levels: encouragement of the patient to ask questions, training of the GP and organization of the practice. An important aspect of the last strategy concerns systematic delegation of health promotion tasks, usually related to the guidelines, to the practice assistant or practice nurse. Recent legislation in the Netherlands underlines and advances the above mentioned trends.

Family Practice↗
PubMed1996

Coordination of care: effects on the continuity and quality of care.

Chronically ill elderly clients in three communities in the Netherlands were provided with the services of care coordinators. Two studies were performed to evaluate the effects of this intervention. A study among 38 coordinators addressed the effects on the continuity of care. A second study among 72 elderly clients addressed the effects on client satisfaction. While the study among coordinators clearly revealed effects on continuity (especially for interpersonal continuity), hardly any effects on satisfaction with care were reported by clients. Therefore, the appointment of care coordinators seems valuable when aimed at increasing continuity, but other interventions can be more appropriate for the improvement of client care.

Aged↗
PubMed1996

Longitudinal study on quality of life and social support in cancer patients.

The aim of the present study is to acquire insight into the changes of quality of life, social networks, and social support of cancer patients during the first year after diagnosis, as well as into the relation between social support and the changes in quality of life. Newly diagnosed cancer patients (n = 51) were followed for 1 year. Semistructured personal interviews and questionnaires were used to gather data. On the average, patients' functioning improved and the amount of physical complaints decreased over the year. Psychological complaints and the global evaluation of life, however, did not change significantly over time. The patients were supported by small, dense networks, consisting mostly of family members. Size of the networks as well as the amount of emotional support showed some decrease over time. It appeared that emotional support was positively related to quality of life. Moreover, a tendency was found to indicate that patients with a deterioration in quality of life perceived a larger decrease in emotional support than patients with a positive course. The amount of perceived instrumental support did not change significantly. There is a tendency that patients who were functioning worse had a greater need for instrumental support. Although these findings indicate relations between types of support and quality of life, we cannot make statements on the causality of these relations.

Adult↗
PubMed1996

Comorbidity in people with Down's syndrome: a criteria-based analysis.

The aims of this study were to review what is currently known about comorbidity in people with Down's syndrome and to determine if their relative risk for certain disorders was increased. Analysis was carried out on the published literature from 1982 through 1994. In order to be included in this study, articles had to meet predetermined criteria. The strengths and weaknesses of the selected articles were considered in this review. The estimation of relative risks was done by calculating the odds ratio (OR). Odds ratios of > 2 or < 0.5 were found in more than one article for congenital heart defects, hypothyroidism, hearing impairment and hepatitis B. Only one article indicated an OR within this range for all of the following disorders: obesity, epilepsy, degenerative spine disorders and a wide atlanto-axial distance. The results were unclear in the areas of hyperthyroidism, visual disorders, dementia and psychiatric disorders. The concept of comorbidity, i.e. establishing the relationships between the various conditions in one person and understanding the implications for medical care, seems promising, especially for people with intellectual disability. Further work in this area may well improve the quality of care offered to these people.

Adolescent↗
PubMed1995

Effectiveness of joint consultation sessions of general practitioners and orthopaedic surgeons for locomotor-system disorders.

Joint consultation sessions between general practitioners (GPs) and specialists to examine patients for whom decisions about referral are difficult are thought to be helpful, but their effects have not been evaluated. In a randomised, controlled trial we studied the effects of joint sessions of GPs and orthopaedic surgeons on referral and intervention rates. During 1.5 years, 12 GPs (in groups of three) held monthly joint consultation sessions with four participating orthopaedic surgeons: patients were seen by one orthopaedic surgeon in the presence of three GPs. Patients were included in the trial if the GP was uncertain about the diagnostic or therapeutic management and if referral was considered; and excluded if referral was urgently necessary or if there was some other clear indication for referral. By a randomised consent design, patients were assigned to joint consultation sessions (n = 144) or a usual-care control group (n = 128). A year later the patients were examined by an independent orthopaedic surgeon. There were significantly fewer referrals (51/144 [35%] vs 87/128 [68%], p < 0.01) and diagnostic actions in the intervention group than in the control group, without negative effects on health or functional status. More patients in the intervention group were symptom-free at 1 year (35% vs 24%, p < 0.05). Joint consultation sessions of GPs and orthopaedic surgeons within the framework of general practice resulted in more efficient care, with better targeted examination, treatment, and referrals.

Family Practice↗
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

Implementing coordination of care--task performance and problems encountered.

In recent years the effects of interventions in the field of coordination of care have been well reported. However, the implementation of coordination of care is hardly addressed. This article focuses on the implementation of coordination of care for the elderly in three community settings in The Netherlands. A group of 38 professional and non-professional care-givers functioned as coordinators during a period of one year. Open interviews with coordinators, minutes from group meetings and forms and logbooks were used as sources of data. Major problems during implementation involved conflicting roles, preserving the client's privacy, lack of recognition and the perception that coordination was not always necessary. Coordinators had no difficulty in making a care inventory and in organizing care. On the other hand, introducing oneself as a coordinator, and planning and evaluating are tasks that need more attention in future interventions.

Aged↗
PubMed1995

Non-acute abdominal complaints in general practice: diagnostic value of signs and symptoms.

BACKGROUND: Although many patients are evaluated initially by their general practitioner, clinicians' accuracy at diagnosing organic gastrointestinal disease has not been studied in a primary care setting. Different spectra of severity of disease in general practice and hospital populations may lead to different values for diagnostic tests in these two populations. AIM: This study set out to determine the diagnostic value of history and physical and laboratory items for organic and neoplastic disease in general practice patients with nonacute abdominal complaints. METHOD: The one-year prospective, observational study was carried out in 1989 in 80 general practices in Limburg, the Netherlands. The study subjects were 933 patients (aged 18-75 years) presenting to their general practitioner with new non-acute abdominal complaints of minimum duration two weeks, and with whom the doctor had a diagnostic problem. Patients were physically examined by their general practitioner and asked to complete pre-structured questionnaires. Basic laboratory tests were carried out. Patients were followed up for at least one year by researchers and then a diagnosis was determined by an independent panel of three general practitioners using patient records, blinded for the results of the questionnaires. Sensitivity, specificity and odds ratios were calculated for clinical items. Stepwise forward logistic regression analysis was undertaken to identify independent predictors of organic gastrointestinal disease. RESULTS: Of the 933 patients 14% had organic gastrointestinal disease. No clinical item had both high sensitivity and specificity. Logistic regression analysis showed only eight independent predictors of organic disease: male sex, greater age, epigastric pain, no specific character to pain, pain affecting sleep, history of blood in stool, no pain relief after defecation and abnormal white blood cell count. When the model was programmed to predict neoplasms five items were found: male sex, greater age, no specific character to pain, weight loss and erythrocyte sedimentation rate greater than 20 mm hour-1. CONCLUSION: In a general practice population with non-acute abdominal complaints some clinical findings can be used as predictors for organic and neoplastic gastrointestinal disease.

Adolescent↗
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

[Transmural teaching program from the family practice viewpoint].

OBJECTIVE: Evaluation of an experimental transmural teaching programme for postgraduate students following a general practitioners' course. DESIGN: Descriptive. SETTING: Institute for General Practice, University of Limburg, the Netherlands. METHOD: Experiences of 100 students who followed a patient from referral in general practice to the hospital (and back) were evaluated by means of a questionnaire. Questions concerned to what extent learning goals (insight into transferral from general practice to the hospital and the consequences for the patient) had been reached. RESULTS: The satisfaction of the students was moderately positive, but dependent on the briefing of the tutors and the exchange of experiences in the tutorial group. The information given by the general practitioner about the referral, the quality of the organisation in the hospital and the medical treatment received a positive judgment. The attention for the patient's views, and the quality of advice and information in the hospital were unsatisfactory in half of the referred cases, according to the student. Three quarters of the patients had a positive opinion regarding the referral in contrast to only half of the relatives. The pattern of the referred morbidity was comparable to the main health problems in general practice. CONCLUSION: The patient's view of his illness plays a central part in this transmural teaching programme. The results justify similar programmes in other disciplines.

Curriculum↗
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↗
PubMed1994

Discriminant value of symptoms in patients with dyspepsia.

BACKGROUND: Family physicians encounter many pitfalls in managing and treating dyspeptic patients, most of whom are treated in family practice based solely on their signs and symptoms. METHODS: A computer literature search followed by a systematic methodological appraisal was performed to identify studies that evaluated clinical symptomatology in dyspeptic patients. RESULTS: Ten studies, none of which took place in a family practice, fulfilled our inclusion criteria. The main conclusion drawn from outpatient populations and patients referred for open-access endoscopy was that certain clusters of symptoms have a negative predictive value for organic causes of dyspepsia. Higher age, male sex, pain at night, relief by antacids or food, and previous history of peptic ulcer disease were identified as predictors of organic causes for abdominal symptoms. CONCLUSIONS: These findings can be helpful to family physicians in determining the need for endoscopy referral. However, since the diagnostic values of tests in family practice may differ from those in referred populations, there is a need for prospective studies in primary care.

Dyspepsia↗
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

Abdominal pain in general practice.

Five hundred and seventy-eight consecutive cases of non-acute abdominal pain presenting to 11 general practices were included in a descriptive study and were followed during 15 months. Females predominated in the younger age groups. Eighty per cent of these patients visited their GP not more than three times for abdominal complaints during the follow-up period. Eighty-three per cent were managed entirely in the practice and 64% received a prescription. Only 20% of patients were additionally investigated in any way by the GP. There were hardly any differences in final diagnoses between patients who had complaints less than 1 week or more than 1 week before presenting to the GP. Non-acute abdominal pain is a condition that is seen and managed mainly in general practice.

Abdominal Pain↗