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Biomedical subjects

I M Okkes

Publications and source records attributed to I M Okkes.

9 recordsLinked to original sources
PubMed2002

The probability of specific diagnoses for patients presenting with common symptoms to Dutch family physicians.

OBJECTIVE: Our goal was to develop reliable data on the probability of specific diagnoses among patients of family physicians (FPs) presenting with common symptoms. STUDY DESIGN: A group of 54 Dutch FPs recorded the reasons for encounter, diagnoses, and interventions for all episodes of care between 1985 and 1995. Diagnoses could be modified during the episode of care, and a modified diagnosis was applied to all episode data. POPULATION: We used the listed patient populations of the 54 Dutch FPs, representing 93,297 patient years, 236,027 episodes of care, and 267,897 patient encounters. OUTCOMES MEASURED: The top 20 diagnoses related to 4 selected presenting symptoms (cough, shortness of breath, general weakness/tiredness, and low back symptom/complaints without radiation), per 100 patients, with 95% confidence intervals, stratified by age. In the standard tables, age-specific cells with fewer than 10 observations were excluded. RESULTS: The availability of an accurate estimate of prior (pretest) probabilities for common symptoms/complaints has great potential value for family practice as an academic discipline and for family physicians in that it can support their medical decision making. Stratifying data by age groups increases the clinical relevance of the prior probabilities. CONCLUSIONS: Though collected by Dutch FPs, the data in our study have a high face validity for other clinicians. Still, FPs in other countries should give priority to collecting their own probability databases.

Adolescent↗
PubMed2001

Advantages of long observation in episode-oriented electronic patient records in family practice.

From 1985-2000, 58 Dutch family physicians (FPs) of the Transition Project collected ICPC-coded data on 47, 2451 episodes of care, first in paper records for direct encounters only, later with a complete electronic patient record (EPR) for all (direct and indirect) encounters. Based on these data, the effects of a long observation period and the inclusion of all encounters (both direct and indirect) in the EPR were studied. Long observation periods in EPRs appear to have important advantages for patient documentation and the assessment of the content of family practice. Comparison of data from a one-year versus a four-year observation period showed a shift in utilization rates. In a long observation period, visiting patients appeared to make less demand on care, while the content of the FP's care for selected chronic diseases was reflected more realistically. The inclusion of all indirect encounters in an EPR (as compared to the previous inclusion of direct encounters only) resulted in more than twice the number of coded entries per listed patient, and thus led to a major shift in perspective on the FP's involvement in patient care.

Adolescent↗
PubMed1999

[Post-traditional medicine. Negotiating about the complaint, diagnosis and therapy].

Dutch health care is developing in the direction of posttraditional medicine: a dynamic system of demand and supply, in which the media, information technology and a more active attitude of the patient play a part. The nature of the complaint/diagnosis combination affects the degree to which therapy is or is not evidence-based and can be medically justified. Randomized studies and guidelines in itself do not lead to a more purposeful application of treatment. Patients persistently request interventions that are not medically justified, but rather have various non-medical aims. Physicians can regard demands of this nature as an encroachment on their authenticity and find it difficult to decide whether or not to comply with them.

Evidence-Based Medicine↗
PubMed1999

[Patients with fatigue in family practice: prevalence and treatment].

OBJECTIVE: To gain insight into the prevalence and treatment of severe fatigue in general practice. DESIGN: Secondary data analysis. METHOD: By means of an episode-oriented morbidity registration by 54 GPs throughout the Netherlands over the period 1985-1994 it was established how often in the course of one year 'fatigue' was listed as the reason for consultation, what diagnoses were then made, how long episodes of care because of 'fatigue' lasted and what interventions took place (n = 93,297). Of the patients with a care episode because of 'fatigue' lasting at least 6 months, age, sex, comorbidity and consumption of care were established; for this purpose use was also made of a file containing data on 4 years in succession (n = 9630). RESULTS: Per annum, 92 per 1000 listed patients consulted the GP because of fatigue. Somatic or psychic diagnoses were made in 27.7 per 1000 patients listed. The episode of care lasted 4 weeks at most in 86% and at least 6 months in approximately 4%. The GPs' management of patients with 'fatigue' included physical examination in 63% and blood testing in 34%, conversation in 35%, prescription of medication in 24% and referral to a specialist in 3%. Of the 97 patients with fatigue lasting longer than 6 months, 61% had a chronic disease or psychic problems. CONCLUSION: Fatigue is frequently encountered in general practice, but the estimate that one per 1000 listed patients meets the criteria of the chronic fatigue syndrome looks a little high. It appears that GPs, in accordance with recommendations, mostly adopt a policy of wait and see.

Adult↗
PubMed1998

[Is the difference between the educational requirements and the final standards of medical studies a problem?].

Last year a ministerial order was issued concerning the requirements of the study of medicine, stating the general end terms and listing health problems as a starting point for this study. The end terms have been made less specific than they were in the first draft, to achieve compatibility between existing European guidelines and Dutch education legislation. The list of problems is not in keeping with this, however. Furthermore, problem-oriented education that meets the end terms requires information about the age and sex-specific distribution of diseases. Owing to the continuous morbidity registration by general practitioners, part of this information is already present and more is expected to become available.

Curriculum↗
PubMed1997

[Mood disorders in daily practice; the North American consensus statement on the undertreatment of depression].

The American National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression may have consequences for the treatment of patients in the Netherlands. It is concluded that Dutch clinicians, also, can be expected to play a more active role in cases of mood disorders than formerly. A comparison of the definitions of depressive disorder in the available classification system results in the recommendation to be strict about the distinction between severe and moderate depressive disorders on the one hand and subthreshold or mild conditions on the other. It is expected that this will limit the anticipated shift towards a more general willingness to use pharmacotherapy for mood disorders in patients in whom this can be expected to be efficacious.

Antidepressive Agents↗
PubMed1997

[Variable rates of diseases in health survey and family practitioners' registries].

OBJECTIVE: To compare the data from the health survey of the Central Bureau for Statistics (CBS: about episodes of chronic diseases experienced by those questioned) and from general practice registration projects (regarding episodes of care). DESIGN: Descriptive. SETTING: Department of General Practice, Academic Medical Centre, Amsterdam, the Netherlands. METHOD: Frequency figures from the CBS health survey regarding chronic diseases for 1992 were compared with data from three large continuous general practice registration projects: the Amsterdam Transition Project, the Nijmegen Continuous Morbidity Registration and the fourth British National Morbidity Study. From the Transition Project not only one-year data were used but also data referring to a four-year period (1989/'93). RESULTS: Incidence and prevalence figures concerning illness and care were in good agreement regarding cardiovascular diseases, uterine prolapse, diabetes mellitus, thyroid disorders, epilepsy and cancer. The health survey had higher frequencies than the GP registration for respiratory disorders, hypertension (both mostly in the age group 25-44 years) gastrointestinal disorders, articular disorders and migraine. With regard to a number of diseases, the four-year registration was in better agreement with the health survey than the one-year registration (e.g. joint disorders): with other disorders the reverse was true (e.g. stroke). CONCLUSION: There were similarities as well as differences between the frequencies from the health survey and the general practice registration projects. Regarding a number of these differences interpretation was possible by using not only one-year data from the GP practice but also data concerning a longer period (4 years) and by comparing the information for different age groups.

Adult↗