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At least 469 records · Page 26Linked to original sources
PubMed1999

[Summary of the guideline 'Osteoporosis' of the Dutch College of General Practitioners. Dutch College of General Practitioners].

The Dutch College of General Practitioners issued a standard 'Osteoporosis' with guidelines for prevention, diagnosis and treatment in patients who have a (probably) osteoporotic fracture, who are taking at least 7.5 mg corticosteroids per day for at least six months or who have questions about osteoporosis. The core of the management is information about lifestyle (stimulation of physical activity) and nutrition. Prevention of falling is to be stimulated; sedatives, excessive drinking and smoking are to be discouraged. Persons who cannot achieve a calcium intake of 500 mg/day, patients with osteoporotic fractures and takers of biphosphonates or corticosteroids whose calcium intake is insufficient are eligible for calcium suppletion. In patients with (probably) osteoporotic fractures and those taking 7.5 mg corticosteroids per day for longer than six months preventive treatment may be considered with alendronic acid for a maximum of 3 years, if several vertebral fractures are visible roentgenologically, the T score is < -2.5 (if age < 70 years) or the Z score < -1.0 (> 70 years).

Female↗
PubMed2002

[The Dutch College of General Practitioners practice guideline 'The menopause'; reaction of the field of general practice].

The Dutch College of General Practitioners' practice guideline on the menopause will not be any major cause for discussion. The hot issue of giving oestrogens to peri- and postmenopausal women to prevent osteoporosis or cardiovascular disease was already covered in the practice guideline on osteoporosis. This guideline on the menopause shows that there is no consensus on when it is safe to stop contraception. The advice to use supplementary contraception, such as condoms, until 1 year after the last menstruation will not be met with a high rate of compliance. If oestrogen therapy is necessary in women with serious vasomotor symptoms who still have their uterus, calendar packets containing 14-16 oestrogen-only pills and 12-14 oestrogen/progesterone combination pills can be used. Administration of transdermal oestrogens has no added value and is more expensive. Tibolone is even more expensive and has more side effects. Clonidine is less effective but can be an alternative for women who choose not to take hormones or in whom oestrogens are contraindicated.

Cardiovascular Diseases↗
PubMed2002

[Medical research in general medicine: activities of the Lausanne General Medicine Division].

Primary care research activities conducted by the General Medicine Division of Lausanne are described here in the light of three studies: practitioners use of ultra-sonographic examinations, early detection of vitamin B12 deficiency and interaction between iron deficiency and fatigue by young women. Primary care research interest as well as its limits and difficulties are discussed.

Biomedical Research↗
PubMed2002

[The sleep apnea syndrome: diagnosis and management in general practice. A descriptive survey of 579 French general practitioners].

General practitioners (GP's) should be the first to recognise the sleep apnoea/hypopnoea syndrome (SAHS) and could play a major role in the follow up of patients treated with continuous positive airways pressure (CPAP) at home. We have carried out a prospective study in order to evaluate the knowledge and diagnostic and therapeutic practice of GP's in relation to SAHS. 579 GP's agreed to participate in the study by means of a telephone questionnaire. Although daytime somnolence and the presence of apnoeas and snoring were the most frequently quoted clinical symptoms suggesting the diagnosis of SAHS, a combination of these symptoms was quoted in only one third of cases. On the other hand the complications of SAHS were not well known by GP's as only 25% of them mentioned the possibility of cardiovascular complications; cerebrovascular accidents and arterial hypertension being quoted by only 15% and 8.8% respectively. With regard to the follow up of patients treated with CPAP more than 50% of GP's did not know the minimum duration of ventilation required and 60% did not understand the method of function. These results, which emphasise the underestimation of SAHS and its complications, confirm the need to develop an educational strategy specifically for GP's in an attempt to improve the diagnosis of this disorder and to allow them to take part in the management and monitoring of treatment with CPAP.

Cardiovascular Diseases↗
PubMed2003

[The Dutch College of General Practitioners' practice guideline 'Diagnosis of breast cancer': reaction from the field of general practice].

In the revised practice guideline on the diagnosis of breast cancer, the general practitioner has an important role when, during screening, a woman is found to have an abnormality, before, during and after treatment. Breast clinics allow the situation to be dealt with rapidly, but patients also need time to cope with it all. In young women with breast complaints, but without palpable abnormalities, the practice guideline recommends mammography to be on the safe side. However, in a group with a low prevalence, this carries primarily disadvantages; the patient does need to be properly followed. The policy for patients with a positive family history of breast cancer has been clearly worded.

Female↗
PubMed2003

Bias in patient assessments of general practice: general practice assessment survey scores in surgery and postal responders.

Patient-based measures of the quality of primary care are increasingly important. However, their effective use requires bias to be minimised. Scores on the General Practice Assessment Survey (GPAS) differ according to whether patients are surveyed in the surgery or by post. It is not clear whether these differences relate to the mode of administration or to the types of patients who complete the scale in postal and surgery samples. Regression indicates that the bias reflects both effects and should be considered when GPAS scores are being interpreted.

Adolescent↗
PubMed2004

[The practice guideline 'Rheumatoid arthritis' (first revision) from the Dutch College of General Practitioners: a response from the perspective of general practice].

In the revised guideline on rheumatoid arthritis of the Dutch College of General Practitioners, in contrast to the previous guideline, particular emphasis is given to an early diagnosis. Moreover, rapid and maximal suppression of the disease process is recommended to delay or prevent damage to the joints. This policy however does not take into account the lack of evidence with regard to improvement of prognostic disability parameters. A careful, individualized referral indication is necessary so as to reduce the chance that patients are referred and treated but later turn out not to have had rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed1992

Exposure to hepatitis B virus in the general population of Hisayama, Japan: significance of isolated antibody to hepatitis B surface antigen in general population.

Cross-sectional survey on the prevalence of hepatitis B serological markers was performed in 2,411 residents who accounted for 74.4% of the population aged 40 and over and living in Hisayama Town, Japan, in 1983. Overall prevalences were 40.7% for both anti-HBs and anti-HBc, 6.1% for isolated anti-HBs and 5.4% for isolated anti-HBc. The condition with isolated anti-HBs was different from those with isolated anti-HBc and both anti-HBc and anti-HBs as follows. The titer of anti-HBs in isolated anti-HBs positive samples was significantly lower than that in both anti-HBs and anti-HBc positive ones (46.2 +/- 5.4 vs. 83.2 +/- 2.8, mean +/- SE, p less than 0.001). The presence of isolated anti-HBs was neither significantly more frequent in males nor related to the risk of liver damages in contrast with that of anti-HBc with or without anti-HBs. These findings suggest that isolated anti-HBs pattern with the absence of anti-HBc in general population was not due to prior HBV infection, but due to natural immunization with HBsAg.

Adult↗
PubMed2004

[The practice guideline 'Hypertension' (third revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

In the revised practice guideline on hypertension from the Dutch College of General Practitioners, some changes have been made in the areas of diagnosis and therapy in comparison to the previous edition. Finding people with hypertension is a major goal for the prevention of cardiovascular disease. A systolic blood pressure > 140 mmHg (> 160 mmHg in patients > 60 years) necessitates non-pharmaceutical advice and antihypertensive therapy with diuretics, beta-blockers, angiotensin-converting-enzyme (ACE) inhibitors or calcium antagonists, either as monotherapy or in combination. In view of the ever-increasing importance of ACE inhibitors in antihypertensive therapy, we expect that the next revision of the practice guideline will soon be necessary.

Age Factors↗
PubMed2005

[The practice guideline 'Depressive disorder' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The revised Dutch College of General Practitioners' practice guideline 'Depressive disorder' no longer distinguishes between mild and severe depression because the management in both cases is identical. This guideline focuses much attention on diagnosis, support and information, all of this in dialogue with the patient. The choice between the antidepressants, a tricyclic antidepressant or a specific serotonin reuptake inhibitor is based on the contraindications of these drugs.

Antidepressive Agents↗
PubMed1992

How long do general practitioners remain in any one location?: Regional and urban size variations in the turnover of foreign and New Zealand doctors in general practice, 1976-90.

Studies of doctor location have, for the most part, focused on geographic variations in access to care, rather than the continuity of care provided at different locations. This paper examines regional and city size variations in turnover rates in general practice and shows that they are highest in the southern and most rural regions of New Zealand. However, an unexpected finding was that no significant differences occurred by doctor origin. While more foreign than New Zealand medical graduates have located in rural New Zealand, similar turnover rates between the two groups indicates that their presence has not resulted in any improvement in the continuity of care provided.

Cohort Studies↗
PubMed2005

[The practice guideline 'Lower urinary-tract symptoms in middle-aged and elderly men' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

Recent research has shown that the simple pathophysiological concept which explains micturition complaints in elderly men as being caused by benign prostatic hyperplasia needs to be abandoned. It has been shown that there is no clear correlation between prostate volume and voiding problems and also that reductase blocker drugs which specifically decrease prostate volume do not lead to a clinically important reduction in symptoms. The internationally accepted new conceptual umbrella description of these micturition problems is 'lower urinary-tract symptoms', a term that is more suited to research this area where a good understanding of the fundamental underlying mechanisms is lacking. The Dutch general practitioners' guideline for micturition problems in elderly men addresses this paradigm change in a thorough and easily understandable way.

Aged↗
PubMed2005

[The practice guideline 'CVA' from the Dutch College of General Practitioners; a response from the perspective of general practice].

The practice guideline from the Dutch College of General Practitioners regarding the diagnosis, treatment and follow-up of a patient with a cerebrovascular accident recommends the patient's referral to a so-called 'stroke-unit'. Thrombolysis within 3 hours after the onset of a stroke should be reconsidered, although its effectiveness remains disputable. The guideline does not explicitly address the GP's responsibility for secondary prevention. The role of the GP in the process of rehabilitation and follow-up in the years after the CVA is described in detail. In so doing, this phase gets the attention it deserves.

Humans↗
PubMed2006

[The practice guideline 'Headache' from the Dutch College of General Practitioners; a response from the perspective of general practice].

The practice guideline 'Headache' from the Dutch College of General Practitioners, which replaces the guideline 'Migraine', is an improvement in many respects: tension headache and substance-induced headache are discussed in detail, the headache diary is given due emphasis and the recommended treatment for migraine is well-balanced. The symptom-oriented approach is, however, not applied consistently in this guideline and too little attention is given, in particular, to the exclusion of serious causes that are less commonly encountered. The guidelines for performing physical examination provide insufficient footing. The exclusion of serious diseases should be based on a limited set of specific physical examinations to be carried out in all cases of new headache. Interrogating the patient about possible social or psychological aspects and the possibility of referral in this area deserve increased emphasis.

Diagnosis, Differential↗
PubMed1991

Elements of a general theory of joints. 6. General kinematical structure of mandibular movements.

Movements of the mandible are recorded in vivo by a measuring system (MT 1602) that takes all 6 degrees of freedom of a rigid body into account. Class-I-patients were asked to move their mandible in the sagittal-vertical plane. The evaluation of the measurements yields an almost plane mandibular movement that only uses 2 degrees of freedom although a general plane movement normally possesses 3 degrees and although the human temporomandibular joint (TMJ) has a certain space of motion. This quantitative reduction of the degrees of freedom by one is produced by a neuro-muscularly guided dimeric link chain that cannot directly be related to anatomical landmarks. The diverse types of mandibular motion of a sound patient differ in the constant ratio of the angular velocities around the 2 axes of the dimeric link chain. Therefore, the paths of the individual mandibular points are epicycloids or hypocycloids. Patients with disorders of the TMJ and the neuromuscular feedback system do no longer show this constancy of the angular velocities' ratio. Besides that, we theoretically derive and empirically prove the fact that common axiographs do not record the "path of the hinge axis" of the TMJ, on principle. In this context we discuss some--in dentistry and anatomy widespread--fundamental misconceptions of the rigid body's kinematics.

Humans↗
PubMed1991

[Coworkers in focus. An analysis of video recordings from receptions in general practice--a method of self evaluation of the coworker and for future development of cooperative forms in general practice].

The article describes a simple method for self-assessment and group-assessment of video recordings from the reception area in a general practice. In a group setting, the method was found to increase the receptionists' confidence in their own professional skills and revealed the need to pay more attention to communication between patients and receptionists. The layout of the reception area was rearranged and changes in the daily routines in the practice were suggested.

Communication↗