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Biomedical subjects

H van Crevel

Publications and source records attributed to H van Crevel.

At least 37 records · Page 2Linked to original sources
PubMed1993

Measuring quality of life in stroke.

BACKGROUND AND PURPOSE: Little attention has been focused on quality of life in stroke outcome research. The purpose of this review is to outline the meaning of the concept, describe important methodological issues and methods of assessment, review existing quality of life measures, and discuss criteria for selecting an appropriate instrument. SUMMARY OF REVIEW: The following 10 quality of life instruments were reviewed: COOP Charts; Euroqol; Frenchay Activities Index; Karnofsky Performance Status Scale; McMaster Health Index Questionnaire; Medical Outcomes Study 20-Item Short-Form Health Survey; Nottingham Health Profile; Quality of Life Index; Quality of Well-being Scale; and the Sickness Impact Profile. They were evaluated in terms of length, time needed to complete, content, scoring, and psychometric characteristics. CONCLUSIONS: Emphasis should be placed on further psychometric evaluation of existing quality of life measures rather than on generating new instruments. There is particular need for supplementary data on the responsiveness of the instruments to changes in patients' clinical status over time. The choice of a suitable quality of life instrument should be based not only on psychometric properties but also on careful consideration of the research question, the relevance to the objectives of the study, the feasibility of the instrument, and the specific characteristics of the stroke patients under investigation.

Activities of Daily Living↗
PubMed1992

[An outpatient clinic for memory disorders; initial experiences].

The department of neurology of the Academisch Medisch Centrum started an outpatient memory clinic in 1987 for patients aged 65 and older. Its specific aims are: assessment of elderly patients with memory problems, treatment where appropriate, and advice; clinical research; teaching and training. The clinic has run full-time since 1990. The approach is multidisciplinary. We describe our findings in the first 75 patients who were referred by their general practitioners because of forgetfulness or possible dementia: 72 of them had a complete investigation; 30 patients were not demented; three could be reassured because their performance was within normal limits. Four patients were depressed and they improved on therapy. Forty-two patients were demented. All had a CT scan and comprehensive blood tests but a curable cause for the dementia syndrome was never identified. This result was expected on account of the probably low frequency of 'reversible' causes and patient selection. Secondary prevention was important when a vascular component contributed to the pathogenesis of the mental deterioration (n = 6). Even when no curable condition was found, clarity about diagnosis and prognosis was important not only to the relatives but also to the general practitioner in planning the future management of the patient. Fifty-five of the 72 patients were older than 65 years which means that we do see the patients we are particularly interested in. The clinic offers facilities for clinical research. In the project 'Diagnostiek bij dementiesyndroom' (Diagnostics in dementia syndrome) we investigate the utility of ancillary investigations in relation to the outcome in demented patients.

Aged↗
PubMed1991

[Consensus cerebrovascular accident].

A consensus conference on stroke was held on March 22, 1991. Subjects on which consensus was reached were: There are different kinds of cerebral haemorrhage and infarction, which can be differentiated by computerized tomography, and this can have practical consequences. At clinical examination special attention should be paid to cognitive impairment. Angiography is indicated only if carotid surgery or unusual causes are considered. CSF examination and EEG are performed only on special indications. Cardiological consultation is necessary in young patients, or if clinical signs of cardiogenic embolism are present. Coumarin derivatives are prescribed in some of these cardiac causes of stroke, to prevent recurrence. There is as yet no effective medical treatment for cerebral infarction. In lobar and cerebellar haemorrhage surgical treatment may be indicated. In the acute phase of stroke it is always important to prevent aspiration pneumonia, pulmonary embolism and decubitus, and to care for muscles and joints. Advantages and disadvantages of gastric tube and indwelling catheter should be weighed. Treatment of hypertension after the acute phase is indicated to prevent recurrent stroke. After TIA and minor stroke, aspirin is prescribed, which reduces the risk of cerebral and myocardial infarction by 30%. Carotid endarterectomy in symptomatic patients with carotid stenosis of 70% or more, reduces the number of fatal or disabling strokes by 50%, if perioperative complications are less than 4%. Rehabilitation after stroke reduces disability and improves the adaptation of both the patient and his environment. The patient should be stimulated and supported; good information, including the family, is essential. Supplying aids and taking special measures should be done on individual basis, after a period of training.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral Hemorrhage↗
PubMed1991

[The effect of publications on clinical practice; chemonucleolysis].

The influence on practice of a publication about a randomised clinical trial of chemonucleolysis (CNL) vs. herniotomy in patients with lumbar prolapsed intervertebral disc was investigated, using a questionnaire sent to neurosurgeons and neurologists. There were no differences between responses of neurosurgeons and neurologists, nor between academic and non-academic specialists. 63 (57%) of the respondents stated they were not influenced by the paper, 48 (43%) stated they were. 40 of those said they thought more favourably about herniotomy, 8 more favourably about CNL. Opinion about CNL and advice to patients about CNL had no effect on being influenced or not by the article. However, they did modify the direction of influence: both negative and positive opinions about CNL appeared to be reinforced by the publication. Opinion about the best treatment and advice to patients were not fully consistent with each other.

Decision Making↗
PubMed1991

Assessing the severity of dementia. Patient and caregiver.

In dementia there is cognitive impairment, disability in daily life, and sometimes behavioral disturbance. These changes are a burden for the caregivers of patients with dementia. Few studies are available that examine all these aspects and their interrelationships in a single patient group. In our study we selected detailed methods for assessment of all these aspects. Interrelationships were studied in 30 mild to moderately impaired patients with dementia and their caregivers. Although the relations of cognitive deterioration to disability in daily life and of burden experienced by the caregiver to patient's condition were stronger than often reported, it was impossible to deduce the overall severity of dementia from one single aspect. Thus, for effective management of patients and caregivers, for evaluation of individual treatment or of clinical trials, attention should be paid to all the different aspects of patients' condition and caregivers' burden. Outcome measurements will then be more valid.

Activities of Daily Living↗
PubMed1990

Reliability of the clinical and electromyographic examination of tendon reflexes.

The reliability of clinical examination of the tendon reflexes was examined by studying inter-observer agreement. Twenty patients were examined by three neurologists. The briskness of the tendon reflexes in arms and legs was scored on a nine-point scale. In 28% of the 160 examined reflexes the observations disagreed 2 scale units or more. Disagreement on the presence of asymmetry occurred in 45% of the 80 reflex pairs. In 15% one observer judged a reflex pair to be symmetrical while another observer found asymmetry of at least 2 scale units. In a second experiment clinical observation of apparently asymmetrical quadriceps reflexes was compared with measurement by surface electromyography. A significant, semi-logarithmic relationship was found between clinical scores and measured reflex amplitudes. Measured reflex asymmetry always agreed with clinical asymmetry, and the magnitudes of right-left amplitude differences were correlated with the magnitude of clinically observed asymmetry. The bedside examination of tendon reflexes is subject to considerable inter-observer disagreement.

Adult↗
PubMed1989

Tendon reflex asymmetry by voluntary mental effort in healthy subjects.

The effect of voluntary mental influences on the tendon reflexes was examined in healthy subjects. The patellar reflexes were evoked by a method comparable with the clinical examination, and the reflexes were recorded by surface electrodes. Eighteen subjects were instructed to increase and then decrease the right patellar reflex by mental effort, without contracting any muscles. Most subjects increased the reflex in both conditions. Subsequently, ten subjects were instructed to increase the right patellar reflex and decrease the left by mental effort. Measurement showed reflex asymmetry in seven subjects consistent with the instruction. The experiment was repeated in another 20 subjects with symmetric reflexes at rest. Ten of these subjects were, after random assignment, instructed to increase either the right or the left knee jerk. All subjects (and an additional 15 asymmetric control subjects) were examined by a neurologist without knowledge of the instruction. Three of the ten instructed subjects were correctly judged to be asymmetric, but the agreement between instruction and neurologic judgment was not statistically significant. Mentally induced reflex asymmetry is possible, and may be clinically relevant in some cases.

Adult↗
PubMed1989

Measurement of tendon reflexes by surface electromyography in normal subjects.

A simple method for measuring the tendon reflexes was developed. A manually operated, electronic reflex hammer was applied that enabled measurement of the strength of tendon taps. Reflex responses were recorded by surface electromyography. Stimulus-response relations and latencies of tendon reflexes in the biceps, triceps, quadriceps and triceps surae were examined in 40 healthy subjects. A characteristic relation between stimulus strength and response amplitude was found which could be described by an empirical function. Latencies of both arm and leg reflexes were linearly related to the height of the subjects. Variations of reflex amplitudes within and between subjects were comparable with previous results obtained with more complicated techniques. Although repeatability of measurement of the amplitude is limited by the variability of reflexes, significant agreement was found between repeated measurements. Most reflex amplitudes were diminished during repeated examination after a short interval. Both measurement and clinical examination showed the frequent occurrence of left-right asymmetry of reflex amplitudes. These left-right differences were reproducible to a significant degree on repeated measurements after more than 2 years.

Adult↗
PubMed1988

Outcome of aneurysmal subarachnoid hemorrhage in patients 66 years of age and older.

The outcome at three months after aneurysmal SAH in a group of older patients and a group of younger patients is compared. The patients were admitted within 72 hours of their SAH. Of 61 patients 66 years of age and older, comprising 13% of the whole patient group, 52% died, 12% remained dependent and 36% became independent. In the younger group, 55% had an independent outcome (p less than 0.01). In contrast to what we expected in the older patient group, not extracranial, but intracranial events (re-bleeds, infarcts, hydrocephalus) were by far the most frequent cause of deterioration.

Age Factors↗