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J Denekens

Publications and source records attributed to J Denekens.

31 records · Page 2Linked to original sources
PubMed2000

Antibiotics for coughing in general practice: a qualitative decision analysis.

BACKGROUND: In family practice, medical decisions are prompted most often by complaints about coughing. There is no single yardstick for the differential diagnosis of respiratory tract infections (RTIs). In 80% of cases, the excessive use of antibiotics in the treatment of RTIs is caused by the prescription behaviour of GPs. OBJECTIVE: Our aim was to explicate GPs' diagnostic (and therapeutic) decisions regarding adult patients who consult them with complaints about coughing, and to investigate what determines decision making. METHODS: Exploratory, descriptive focus groups were held with GPs. Hypotheses were generated on the basis of 'qualitative content analysis'. Results. Twenty-four GPs participated in four semi-structured group discussions. In order to differentiate RTIs from other possible diagnoses, less likely diagnoses were not ruled out explicitly. In the case of suspected RTI, there was a low degree of certainty in the differentiation between RTIs (e.g. between bronchitis and pneumonia). Clinical signs and symptoms, which determine the probability of disease, often left GPs with reasonable diagnostic doubt. In the end, the decision whether or not to prescribe antibiotics was taken. GPs' prescription behaviour was also determined by doctor- and patient-related factors (e.g. having missed pneumonia once, patient expectations). The 'chagrin factor' explains why these factors lead to a shift in the action threshold, in favour of antibiotics. CONCLUSION: This inductive research method enabled the generation of meaningful hypotheses regarding the complex decision processes pursued by GPs. The authors are developing an educational intervention that builds on these findings, focusing on the prescribing decision.

Adult↗
PubMed2000

[Education in basic clinical skills for doctors].

There was reason to believe there were problems regarding basic clinical skills in the medical undergraduate curriculum. 106 students from three groups of final year students at two medical schools (i.e. all general practice students at Antwerp en Ghent, and a selection of future specialist students at Antwerp), were studied in a twelve station, 13 minute per station OSCE (Objective Structured Clinical Examination). In the OSCE a range of basic diagnostic and therapeutic skills was assessed. Results showed poor overall performance, even on stations related to the compulsory clerkships. Subsequently we make recommendations for improving the present situation of training in basic clinical skills.

Belgium↗
PubMed1999

General practitioners caring for terminally ill patients resident in a hospice.

The goal of this study was to investigate why GPs have little or no involvement in the medical process relating to any of their patients when they are admitted to a palliative care unit (PCU) and what solutions they suggest. The study took the form of a descriptive pilot study based on a short questionnaire. It emerged that GPs felt their involvement was influenced by their job description, by practical factors (time investment, distance between practice and PCU, remuneration, referral) and personal issues (e.g. dealing with dying). It is concluded that GPs need education in palliative/supportive care and approved remuneration as well as knowledge about their task in the PCU.

Attitude of Health Personnel↗
PubMed1999

Can medical schools rely on clerkships to train students in basic clinical skills?

OBJECTIVE: Many medical schools have drawn up lists of basic clinical skills that students are required to have mastered at the end of medical training. To determine whether undergraduate students actually perform these basic clinical skills during clerkships and whether different approaches to skills training led to different results, we surveyed 365 final-year medical students in 1996 and 1997. METHOD: A questionnaire containing items on 265 skills in eight body systems was administered to students from two conventional medical schools (Ghent and Antwerp, Belgium), and one Dutch medical school, Maastricht, which offers a problem-based curriculum and systematic skills training. RESULTS: Although quite a few skills were not performed by Maastricht students, the results of this school compared favourably to those of the Ghent and Antwerp medical schools. Significant differences between Ghent and Antwerp were found for surgery, paediatrics and gynaecology/obstetrics. In the non-obligatory clerkships in dermatology, otorhinolaryngology and ophthalmology a great percentage of skills were not performed. CONCLUSIONS: The main conclusion is that all three medical schools cannot rely on clerkship experiences alone to provide adequate basic skills training. A problem-based learning environment and training in a skills laboratory appear to result in students performing more skills during clerkships. Assessment of clinical skills, obligatory clerkships in specialties and general practice, and continuous monitoring of the quality of clerkships may also be strong determinants of the present findings.

Belgium↗
PubMed1993

[Sterilization and the mentally handicapped: who decides?].

At the moment sterilization of mentally handicapped persons is carried out in a medical and a legal vacuum in Belgium as well as abroad. To give an adequate answer to the problem of sterilization of mentally handicapped adolescents in medical practice, Dr. J. Denekens undertook an extensive literature review and an empirical investigation comprising case-studies of 52 adolescents, their parents and family doctors. The adolescents, between the ages of 16 and 21, were selected at random from students attending schools for mentally handicapped persons in the province of Antwerp during the school year 1989-1990. This study and investigation resulted in the formulation of medical and ethical criteria to assist decision makers confronted with a request for sterilization from or on the behalf of a mentally handicapped person who may be unable to decide this issue alone. These criteria have been ordered in a useful and practical algorithm that enables a motivated, logical and ethically responsible decision to be taken. A proposal of procedure for such a sterilization request has been elaborated. The medical-ethical criteria, the algorithm and the procedure proposal come out right in time as the European Parliament is discussing a motion that deals with the legal part of the subject.

Adolescent↗