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J R Haalboom

Publications and source records attributed to J R Haalboom.

At least 19 recordsLinked to original sources
PubMed2000

['Decubitus' guideline of the Dutch College of Family Practitioners: response from internal medicine].

The guideline on pressure ulcers by the Dutch College of General Practitioners is good in the aspects of simplicity and giving very practical advice. It can be used as a guideline for prevention as well as treatment of pressure ulcers. Some aspects, however, are insufficiently dealt with. There is no summing up of the differences in anti-pressure ulcer devices such as mattresses and cushions. Use is made of the international classification of pressure ulcers in 4 stages, but also of a kind of rating in three colours (red-yellow-black), of which it is known that it underestimates the severity of pressure ulcers. There is an advice to use the knowledge of surgeons, dermatologists and nursing home doctors in difficult cases in the home care, where training and deployment of nurses specialised in this specific field might be preferable. Nevertheless, the guideline is well documented and useful in general practice.

Equipment and Supplies↗
PubMed2000

Pressure-induced skin lesions in pigs: reperfusion injury and the effects of vitamin E.

The pathogenesis of the development of pressure ulcers is still unclear. The aim of this study was to investigate the role of ischaemia and reperfusion in pressure-induced tissue necrosis in the trochanteric region in pigs. Pressure application was achieved with a newly developed computer-controlled pressure device. Histological examination showed damage in the subcutis and muscle tissue comparable with inflammation, extending in a vascular pattern beyond the area of pressure application. Electron-microscopic studies revealed neutrophil adherence to the capillary endothelium, which showed signs of injury. These observations were manifest two hours after the cessation of pressure. Pre-treatment with 500 mg vitamin E per day resulted in significantly less tissue damage compared with untreated animals. Pressure alone caused a significant decrease in reduced glutathione and total glutathione, suggesting oxidative stress. After pressure release there was a significant increase in hydrogen peroxide concentration, suggesting a decreased antioxidant protection. After pre-treatment with vitamin E, however, there was no increase of hydrogen peroxide. It is concluded that the early signs of necrosis after pressure application are concordant with typical ischaemia-reperfusion damage and this can be prevented in part by treatment with vitamin E. Prophylactic administration of vitamin E may influence the occurrence of pressure ulcers in humans undergoing elective surgery.

Animals↗
PubMed1999

Risk-assessment tools in the prevention of pressure ulcers.

Some screening tools exist for assessing increased risk of the development of pressure ulcers, but none of these tools has undergone actual testing for validity and predictive value. This is important in clinical practice because the combination of high sensitivity and rather low specificity implies that the number of patients at increased risk is overestimated and thus overtreated (i.e., unnecessary preventive measures are taken). Risk scores are usually composed of items considered to influence the development of pressure ulcers. Although for some scoring systems attempts have been made to enhance specificity by changing the cutoff points or the relative value of individual items, good results have not been achieved. The influence that individual items have on the development of pressure ulcers and the impact of this influence on score outcomes has not yet been established. In this study, 65 patients with and 58 patients without pressure ulcers were compared using all of the known risk factors analyzed by multivariate logistic regression. We found that only the Norton, Douglas, and Dutch Consensus Meeting scoring systems appeared to predict the development of pressure ulcers. Also, it appeared that incontinence for urine and the presence of both neurologic disorders and friction forces to the skin effectively predict the development of pressure ulcers. Considering the important implications of this study, a larger study--consisting of several thousand patients--should be performed to assess in more detail the variables currently perceived as risk factors and construct and evaluate a scoring system based on these results.

Aged↗
PubMed1999

The development of a national registration form to measure the prevalence of pressure ulcers in The Netherlands.

To gain insight into the prevalence of pressure ulcers in Dutch healthcare institutions, a national registration form to measure the prevalence of pressure ulcers annually in different healthcare settings was developed based on a literature study and responses from a Delphi panel. The reliability and the feasibility of the form devised were tested in a pilot study conducted in a university hospital, a nursing home, and in a home healthcare setting. Interrater reliability of the grading system varied between the institutions from 0.49 to 0.97 (Cohen's Kappa). In the home healthcare setting, interrater reliability was 0.80 (Pearson correlation coefficient) for the total score on the Braden scale. The prevalence rates were 10.1% (n = 368) in the university hospital, 12.7% (n = 1,541) in the home healthcare setting, and 83.6% (n = 122) in the nursing home, although the latter figure seemed to be somewhat exaggerated. The most common lesions were found on the sacrum and below the knee (heel and malleolus). The pilot study concluded that it is possible to collect accurate and reliable data on the scope and severity of pressure ulcers with a uniform instrument in different healthcare settings.

Aged↗
PubMed1998

Pressure ulcers.

Explore the source record for details and available documents.

Aged↗
PubMed1993

Extracellular and intracellular magnesium concentrations in asthmatic patients.

Magnesium deficiency is associated with increased contractility of smooth muscle cells. Since contractility of bronchial smooth muscle is important in patients with asthma, magnesium deficiency could negatively influence the clinical condition. We wanted to assess whether magnesium deficiency exists in patients with asthma. Extracellular (plasma) and intracellular (erythrocytes and mononuclear leucocytes) concentrations of magnesium were determined in 20 mildly symptomatic patients with asthma and compared to 20 healthy controls. In asthmatic patients, the mean +/- SD magnesium level in plasma was 0.81 +/- 0.05 mmol.l-1, in erythrocytes 0.20 +/- 0.02 fmol.cell-1, and in mononuclear leucocytes 5.10 +/- 2.55 fmol.cell-1; these values did not differ significantly from those of the healthy controls: 0.79 +/- 0.06 mmol.l-1, 0.19 +/- 0.02 fmol.cell-1, and 4.61 +/- 1.75 fmol.cell-1, respectively. No evidence for the existence of a magnesium deficit needing chronic magnesium supplementation was, thus, found in these patients.

Asthma↗
PubMed1992

[Revision consensus prevention and treatment decubitus].

The text of the Consensus Meetings Prevention and Treatment of Decubitus (pressure sores; 1985 and 1986 respectively) was adapted to current insights into pathogenesis and treatment. This adaptation was important since the costs of the prevention and treatment of decubitus are enormous and decubitus tends to occur more often since the population is growing older. The so called anti-decubitus devices were grouped in 3 categories: 1. polyether foam mattresses, placed on top of the standard hospital mattresses (merely in prevention and in treatment of patients less than 85 kg), 2. polyether foam mattresses with or without special surface layout or simple alternating pressure air mattresses, replacing the standard hospital mattress (especially in patients greater than 85 kg) and 3. special beds and bed systems as low-air-loss beds and air-fluidized beds (only on strict indications such as thoracic operations and intensive treatments). The clinical manifestations of decubitus were classified in 4 stages: non-blanching erythema (1), blister (2), superficial decubitus (3) and deep decubitus (4). The existence of another form of pressure sores was identified: decubitus originating from operation or angiography tables, on which a deep necrosis develops, extending to form an abscess, erupting through the skin after 7-14 days. These ulcers are characterised by an impressive depth, usually to the underlying bones, but with vivid edges. The development of these sores is prevented in most cases by using a category 1 device on the tables mentioned.(ABSTRACT TRUNCATED AT 250 WORDS)

Bedding and Linens↗
PubMed1991

[The costs of decubitus].

In this article the costs of prevention and treatment of decubitus (bed sores) are calculated and an analysis is made of the structure of these costs. Using documented figures on the prevalence of decubitus in hospitals and nursing homes and of prices related to decubitus prevention and treatment as made in a hospital (University Hospital Utrecht, the Netherlands) in which decubitus is treated according to a strict protocol, total costs were calculated by extrapolation. Prevention of decubitus costs Dfl. 95,-per day per patient, treatment of decubitus stages I and II Dfl. 133,-and of stages III and IV up to Dfl. 175,-. These figures result in annual costs of Dfl. 223 million for prevention, Dfl. 125 million for treatment of stages I and II and of Dfl. 122 million for stages III and IV. Together with a mean occupation of hospital beds of 74% this amounts to a total of Dfl. 350 million per year for hospitals and a similar amount for nursing homes, or Dfl. 700 million in all. The costs of decubitus in home care are not known, but believed to be of the same order of magnitude. These figures apply to a total population of the Netherlands of 15 million. Extension of the hospital stay of the patients accounts for 65% of the costs, increase in attendance of nursing staff for 25% and all other actions (physical therapy, dietary adjustments, medication) for only 3%. Special beds cost about 7% of the total amount. The costs of prevention and treatment of decubitus are high (in hospitals and nursing homes alone approximately Dfl. 700 million per year) and tend to increase since the population is growing older and decubitus is occurring mainly in the older population. Only 7% of these costs are spent on the use of special beds. Since the costs of the leasing of these beds are usually not included in the hospital budgets, the financing of these important tools in prevention and treatment of decubitus is increasingly difficult.

Aged↗
PubMed1989

Hypokalaemia in hypertensive patients treated with diuretics: no increase in cardiac arrhythmias.

Hypokalaemia is a risk factor for the development of cardiac arrhythmias, at least in patients with a cardiac disease, but it is not known whether this applies to subjects with normal hearts. In the present study, 8 young patients with essential hypertension were treated with chlorthalidone for 12 wk followed by a combination of chlorthalidone (50 mg/day) and triamterene (100 mg/day) for 6 wk. This protocol was chosen in order to create different phases in the intra- and extracellular potassium concentrations. At the end of each 6-wk period, blood analyses were performed together with whole body counting for 40K, 24-h electrocardiogram registration, and ergometry. Although plasma potassium concentration and total body potassium decreased significantly in the chlorthalidone period and increased significantly in the period when triamterene was administered together with chlorthalidone, no changes in ectopic activity were seen during either 24-h registration or ergometry. It is concluded that, although hypokalaemia may be dangerous in patients with diseased hearts, a similar risk could not be established in subjects with a normal heart and uncomplicated essential hypertension. Whether the conclusion applies to the average patient with essential hypertension is still a subject of study.

Adult↗
PubMed1988

Decrease of plasma potassium due to inhalation of beta-2-agonists: absence of an additional effect of intravenous theophylline.

The effect on the plasma potassium concentration of inhalation of the beta-2-agonists fenoterol, salbutamol (albuterol), and terbutaline from metered-dose inhalers was studied in normal volunteers. All three drugs caused a significant, dose-dependent decrease, more pronounced for fenoterol and salbutamol than for terbutaline. Relative to the bronchodilating potency (one puff of fenoterol 0.2 mg is considered to be equivalent to two puffs of salbutamol 2 x 0.1 mg, or two puffs of terbutaline 2 x 0.25 mg), fenoterol had a more pronounced effect on plasma potassium than salbutamol or terbutaline. The systemic effect on plasma potassium seems to be related to the structure of the drugs: the more lipophilic the drug (fenoterol) the sooner the systemic symptoms appear and the more pronounced they are. The effects of theophylline alone, and combined with fenoterol, were also studied. The intravenous infusion of theophylline (after placebo inhalation; maximal mean plasma concentration 14.9 +/- 2.2 mg l-1) caused a small but significant decrease of plasma potassium. There was no additive or synergistic effect when theophylline was added to fenoterol. It is concluded that inhalation of beta-agonists induces a decrease of plasma potassium, that this effect is relatively more pronounced for fenoterol than either salbutamol or terbutaline, and that it is not enhanced by the concomitant use of theophylline. Theophylline by itself causes a slight decrease in plasma potassium concentration.

Adrenergic beta-Agonists↗