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Biomedical subjects

A M Bohnen

Publications and source records attributed to A M Bohnen.

At least 19 recordsLinked to original sources
PubMed2006

Establishing normal reference ranges for PSA change with age in a population-based study: The Krimpen study.

BACKGROUND: We aim to establish the normal pattern of prostate specific antigen (PSA) change with age to provide a baseline from which disease progression might be identified in prostate cancer patients included in active surveillance programs. METHODS: In a community-based study, PSA values were determined at baseline and after 2.1 and 4.2 years in men without prostate cancer. A bivariate multilevel growth curve model was used to estimate the pattern of change of PSA with age. RESULTS: The final model showed that PSA was related to age only. The future PSA of an individual can be predicted based on his age and known history of PSA. The model was also used to calculate PSA doubling time for men with different PSA values at different ages. CONCLUSIONS: This method establishes normal PSA levels by age using PSA history in men without prostate cancer. The model provides baseline data from which disease progression might be detected.

Age Factors↗
PubMed2006

Epidemiological aspects of recruitment of male volunteers for non-invasive urodynamics.

INTRODUCTION: We studied epidemiological aspects of recruitment of volunteers for a non-invasive urodynamic study. MATERIALS AND METHODS: 9,236 volunteers were invited by 20 general practitioners (GPs), using two different recruitment methods, i.e. by mail only, or during a subsequent visit to the GP's office. Factors influencing the response rates were analyzed. We also tested how much the recruited population of volunteers differed from the general population, by comparing it to another, proven representative study carried out earlier in 1,662 subjects. RESULTS: In the recruited population the prostate volumes were not significantly different from the proven representative study, but the symptom score was statistically significantly higher, although the difference was so small it may be called clinically irrelevant. Recruitment of volunteers in two steps, i.e. asking them first to visit the GP's office, and inviting them there to visit the outpatient clinic, rather than directly inviting them (in writing) to the clinic seemed to lead to a higher response, although this effect could not be statistically discriminated from the difference in response rates between GPs. CONCLUSION: The population recruited was not urologically different from the general population. The response depended on age, being highest around the age of 60, and increased with social economic status. It also depended on the GP who recruited the subjects, and/or on the recruitment method.

Adult↗
PubMed2005

Validity of three calliper-based transrectal ultrasound methods and digital rectal examination in the estimation of prostate volume and its changes with age: the Krimpen study.

BACKGROUND: Prostate volume and its changes are important parameters in studies of the natural history of benign prostatic hyperplasia (BPH), for prediction of treatment effect and the risk of adverse outcomes. The validity of three calliper-based transrectal ultrasound (TRUS) methods and digital rectal examination (DRE) is compared to transrectal planimetric prostate ultrasonometry. METHODS: Data were collected from 1,688 population-based men aged 50-78 years. Measurements included DRE, TRUS using the planimetric method, and three different calliper-based TRUS methods for the estimation of prostate volume. After 2.1 and 4.2 years these measurements were repeated. The agreement between these methods and the ability to discriminate between prostates with volumes above or below a certain cut-off was analyzed. The performance of the different methods to measure changes in prostate volume with age was also studied. RESULTS: All three ultrasound-based methods showed good discrimination compared to the planimetric method. However, the agreement between planimetric volumetry and the other ultrasound methods and DRE is poor. In this study, 22.6% of the men had a real increase in prostate volume after 4.2 years, using the planimetric technique of transrectal ultrasonometry. Only a small percentage of the men (<1.5%) has a real decrease in prostate volume. The alternative measurement methods had a low predictive value for changes in prostate volume with age as measured with the planimetric method. CONCLUSIONS: Calliper-based ultrasonometry and DRE show poor agreement with planimetric volume measurement of the prostate. Changes in prostate volume as determined by the planimetric method are poorly detected by the alternative methods. (c) 2004 Wiley-Liss, Inc.

Aged↗
PubMed2005

Efficacy of fluticasone on cough: a randomised controlled trial.

Cough may be the consequence of bronchial hyperresponsiveness (BHR) and inflammation. This study was designed to investigate the short-term effects of an inhaled steroid (fluticasone propionate (FP)) on cough, and to determine the effects of smoking, BHR, allergy and forced expiratory volume in one second (FEV1) on the efficacy of FP. In a community-based primary healthcare centre, 135 previously healthy adults suffering from cough for > or =2 weeks were enrolled in a randomised, double-blind, placebo-controlled trial of inhaled FP 500 microg b.i.d. for 2 weeks. Participants completed daily diary cards of lower respiratory tract symptoms. The primary outcome measure was the decrease in mean total daily cough score (0-6) during the second week of treatment. In the FP group, the cough score decreased from 3.8 at baseline to mean+/-SEM 1.4+/-0.2 during the second week. In the placebo group, this decrease was from 3.8 to 1.9+/-0.1 and was statistically significantly less. A favourable effect of FP was only detectable in nonsmokers, in whom the score was 0.9 points lower compared with placebo. The clinical relevance of this finding has to be established further. Allergy, FEV1 and BHR at baseline did not affect the efficacy of FP. In conclusion, anti-inflammatory treatment with the inhaled steroid fluticasone propionate reduces cough in otherwise healthy adults who do not smoke.

Administration, Inhalation↗
PubMed2004

[Summary of the practice guideline 'Stable angina pectoris' (second revision) from the Dutch College of General Practitioners].

Typical angina pectoris is characterised by retrosternal complaints that are provoked by exertion, cold, emotional stress or heavy meals and are relieved by rest within 15 minutes or within a few minutes of using sublingual nitroglycerin. If 2 or 3 of these symptoms are present then the term 'atypical angina pectoris' is used. The general practitioner can estimate the risk of significant coronary artery disease on the basis of the anamnesis. Additional diagnostics in the form of an exercise ECG is only worthwhile if the pretest probability of coronary artery disease lies between 30% and 70% (atypical angina pectoris) and not if the diagnosis is extremely likely or extremely unlikely. Patients with angina pectoris should be informed about the alarm symptoms which can be indicative of unstable angina pectoris or acute myocardial infarction. Sublingual nitrate therapy is used for the short-term control of angina. If more than 2 attacks per week occur, a maintenance treatment consisting of beta-blockers, nitrates, or calcium channel blockers should be started in this order of preference. For secondary prevention, acetylsalicylic acid and statins should be prescribed and lifestyle advice should be given, such as smoking cessation, sufficient physical exercise and a healthy diet.

Angina Pectoris↗
PubMed2004

Incidence rates and determinants in meralgia paresthetica in general practice.

OBJECTIVE: To determine incidence rates for meralgia paresthetica (MP) in the primary care setting and establish determinants for MP in a case-control study in general practices. METHODS: Using a cohort (in total 173,375 patient years) of registered persons in primary care from a computerized registration network for general practitioners (GPs) in the Rotterdam area from 1990 to 1998, persons with the diagnosis MP were included. In a nested case-control study we studied the relationship between comorbidity (e. g. carpal tunnel syndrome, pregnancy, osteoarthritis of the hip, overweight, symptoms of the pubic bone, thrombosis of the leg, diabetes mellitus and the use of corticosteroids) and the occurrence of MP. RESULTS: The incidence rate of MP is 4.3 per 10,000 person years. MP is more often present in patients suffering from carpal tunnel syndrome OR 7.7 (95 % CI 1.9-31.1) and is related to pregnancy OR 12.0 (95 % CI 1.2-118.0). CONCLUSIONS: This is the first report on incidence rates of MP and on suspected determinants studied in a case-control setting in general practice. Carpal tunnel syndrome and pregnancy are significantly related to MP. Calculating the Population Attributable Risk in this study leaves 79% of all MP unexplained. Our results suggest that MP is caused by a combined susceptibility for entrapment and a trigger causing entrapment. More research on determinants is needed. Because MP occurs in every GP practice at least once a year more studies are needed on prognosis and treatment.

Adrenal Cortex Hormones↗
PubMed2004

Validity of digital rectal examination and serum prostate specific antigen in the estimation of prostate volume in community-based men aged 50 to 78 years: the Krimpen Study.

BACKGROUND: In men with symptoms suggestive of BPH, an accurate estimation of the degree of prostate volume enlargement is important for the choice of treatment, and for prediction of treatment effect, the risk of acute urinary retention and the need for surgery. In a community-based population of men, the performance of digital rectal examination (DRE) and serum prostate specific antigen (PSA) is compared to planimetric transrectal ultrasonometry (planimetric TRUS) of the prostate. In this way we search for a practical, reliable, and reproducible alternative to TRUS that can be applied in a primary care setting and in the initial evaluation of men with lower urinary tract symptoms. METHODS: Data were collected from 1688 men aged 50 to 78 years recruited in a population-based study. Measurements included serum PSA, DRE, and planimetric TRUS for the estimation of prostate volume. RESULTS: The AUC values of the receiver-operating curves (ROC) curves for serum PSA as a method for the discrimination of prostate volumes above or below 30, 40 and 50 cc are 0.79, 0.86 and 0.92, respectively. DRE has limited value in the estimation of prostate volume and is only good in identifying very large prostates (>50 cc). CONCLUSIONS: In the general male population serum PSA performs reasonably well compared with planimetric TRUS, and better than DRE, in estimating whether prostate volume is greater or smaller than 30, 40 or 50 cc. Serum PSA is an acceptable alternative method to estimate the degree of prostatic enlargement in clinical settings where TRUS is not available and when prostate cancer has been excluded.

Aged↗
PubMed2004

Applicability and reproducibility of condom catheter method for measuring isovolumetric bladder pressure.

OBJECTIVES: To report on the applicability, reproducibility, and adverse events of the noninvasive condom catheter method in the first 730 subjects of a longitudinal survey of changes in urinary bladder contractility secondary to benign prostatic hyperplasia, in which 1300 men will be evaluated three times in 5 years using this method. METHODS: Subjects were recruited by general practitioners, general publicity, and e-mail. Only those meeting the study criteria were entered in the study. If the free flow rate exceeded 5.4 mL/s, at least two consecutive condom pressure measurements were attempted using the condom catheter method. The condom pressure measured reflected the isovolumetric bladder pressure, a measure of urinary bladder contractility. The reproducibility of the method was quantified by a difference plot of the two maximal condom pressures measured in each subject. RESULTS: In 618 (94%) of 659 eligible participants, one condom pressure measurement was completed; two measurements were done in 555 (84%). The maximal condom pressure ranged from 28 to 228 cm H2O (overall mean 101, SD 34). A difference between the two pressures of less than +/-21 cm H2O was found in 80%. The mean difference was -1 cm H2O (SD 18), significantly different from 0. Some adverse events such as terminal self-limiting hematuria were encountered. CONCLUSIONS: The condom catheter method is very suitable for large-scale use. It has a success rate of 94% and a reproducibility comparable to that of invasive pressure flow studies.

Condoms↗
PubMed2003

Abdominal symptoms: do they disappear after cholecystectomy?

OBJECTIVE: To evaluate the effect of cholecystectomy in patients with gallstones on preoperative abdominal symptoms. METHODS: A systematic search was made of the Medline database in combination with reference checking. Articles were excluded if patients aged <18 years, symptom relief rates could not be calculated, if follow-up after cholecystectomy was less than 1 month, or when the included patients were at extraordinary risk for a complicated outcome. Potential differences in relief rates due to patient selection, retrospective versus prospective design, duration of follow-up, or intervention were analyzed using logistic regression. RESULTS: The pooled relief rate for "biliary pain" was high 92% (95% confidence interval 86 to 96%). Symptom relief rates were consistently higher in studies that included acute cholecystectomies. For upper abdominal pain--without restrictions for intensity or duration--pooled relief rates ranged from 72% (66 to 77%) after elective cholecystectomy, to 86% (83 to 91%) after acute cholecystectomy. The relief rate of food intolerance was higher in studies with a follow-up < or =12 months (88%, 76 to 91%) compared to studies with a follow-up of more than 12 months (65%, 55 to 74%). CONCLUSION: In almost all patients with gallstones biliary pain disappeared after cholecystectomy. There is insufficient evidence, however, that this relief was due to cholecystectomy. Relief rates of other isolated symptoms were low in patients with an elective cholecystectomy. A proper evaluation of the effectiveness of cholecystectomy in terms of abdominal symptom relief rates requires a randomized trial.

Abdominal Pain↗
PubMed2002

Prevalence of erectile dysfunction: a systematic review of population-based studies.

A systematic review was conducted on the prevalence of erectile dysfunction (ED) in the general population. Studies were retrieved which reported prevalence rates of ED in the general population. Using a specially developed criteria list, the methodological quality of these studies was assessed and data on prevalence rates were extracted. We identified 23 studies from Europe (15), USA (5), Asia (2) and Australia (1). On our 12-item criteria list, the methodological quality ranged from 5 to 12. The prevalence of ED ranged from 2% in men younger than 40 y to 86% in men 80 y and older. Comparison between prevalence data is hampered by major methodological differences between studies, particularly in the use of various questionnaires and different definitions of ED. We stress the importance of providing all necessary information when reporting on the prevalence of ED. Moreover, international studies should be conducted to establish the true prevalence of ED across countries.

Age Distribution↗
PubMed2001

[General practitioner's workload: objective increase in 9 practices in Rotterdam and surroundings, 1992-1997 and an extrapolation to 2005].

OBJECTIVE: To assess the change in general practitioners' (GPs') workload during the period 1992-1997, calculated as consult frequency and GP-patient contact time, and to estimate the workload in 2005. DESIGN: Descriptive. METHOD: During the period 1992 to 1997, data from all GP-patient contacts from nine general practices in and around Rotterdam, the Netherlands, were registered and stored in a central database. The yearly GP-patient contact time in 1992 and 1997 was calculated using the measured contact frequencies and known figures from the medical literature on the distribution and average duration of the different contact types (consultation, home visit, telephonic consultation, other). The contact time in 2005 was estimated by extrapolating the contact time for the period 1992 to 1997, whilst bearing in mind the expected population composition in 2005. RESULTS: The number of GP consultations increased from 4.26 in 1992 to 5.16 in 1997 (+21%). Compared with 1992, the yearly GP-patient contact time in 1997 was at least 90 hours higher. Extrapolation to 2005, revealed a further increase in this contact time of 667 (+36%) hours compared to 1997. This predicted increase in the workload could mostly be attributed to an increase in the number of elderly patients and the number of contacts with these patients. CONCLUSION: The number of hours worked by GPs increased by 20% over a six year period and is expected to increase by about a third over the next few years.

Adult↗
PubMed2001

Assessment of decision support for blood test ordering in primary care. a randomized trial.

BACKGROUND: Different methods for changing blood test-ordering behavior in primary care have been proven effective. However, randomized trials comparing these methods are lacking. OBJECTIVE: To compare the effect of two versions of BloodLink, a computer-based clinical decision support system, on blood test ordering among general practitioners. DESIGN: Randomized trial. SETTING: 44 practices of general practitioners in the region of Delft, the Netherlands. PARTICIPANTS: 60 general practitioners in 44 practices who used computer-based patient records in their practices. INTERVENTION: After stratification by solo practices and group practices, practices were randomly assigned to use BloodLink-Restricted, which initially displays a reduced list of tests, or BloodLink-Guideline, which is based on the guidelines of the Dutch College of General Practitioners. MEASUREMENTS: Average number of blood tests ordered per order form per practice. RESULTS: General practitioners who used BloodLink-Guideline requested 20% fewer tests on average than did practitioners who used BloodLink-Restricted (mean [+/-SD], 5.5 +/- 0.9 tests vs. 6.9 +/- 1.6 tests, respectively; P = 0.003, Mann-Whitney test). CONCLUSIONS: Decision support based on guidelines is more effective in changing blood test-ordering behavior than is decision support based on initially displaying a limited number of tests. Guideline-driven decision support systems can be effective in reducing the number of laboratory tests ordered by primary care practitioners.

Decision Support Techniques↗
PubMed2001

Erectile and ejaculatory dysfunction in a community-based sample of men 50 to 78 years old: prevalence, concern, and relation to sexual activity.

OBJECTIVES: To determine the prevalence rates of erectile and ejaculatory dysfunction, associated bother, and their relation to sexual activity in a population-based sample of elderly men.Methods. Data were collected from 1688 men by way of self-administered questionnaires (including the International Continence Society male sex questionnaire) and measurements at a health center and urology outpatient department. RESULTS: The prevalence of significant erectile dysfunction (ie, erections of severely reduced rigidity or no erections) increased from 3% in men 50 to 54 years old to 26% in men 70 to 78 years old. In the same age strata, the prevalence of significant ejaculatory dysfunction (ie, ejaculations with significantly reduced volume or no ejaculations) increased from 3% to 35%. Pain or discomfort during ejaculation was rare (1%) and independent of age. In general, men were more concerned about erectile dysfunction than about ejaculatory dysfunction. However, most men had no or only little concern about their dysfunction. The percentage of men who reported being sexually active declined with increasing age and was lower in men with erectile and ejaculatory dysfunction and in men without a partner. In sexually active men, 17% to 28% had no normal erections, indicating that with advancing age normal erections are not an absolute prerequisite for a sexually active life. CONCLUSIONS: Erectile and ejaculatory dysfunction are common in elderly men. The results of this study indicate that these conditions are much less of a problem for older men than previously suggested.

Age Distribution↗
PubMed2001

Voided volumes: normal values and relation to lower urinary tract symptoms in elderly men, a community-based study.

OBJECTIVES: To determine the normal values of voided volumes and explore the relation between bladder capacity and lower urinary tract symptoms (LUTS) in elderly men. METHODS: Data were collected from 1688 men 50 to 78 years old recruited from the population of Krimpen aan den IJssel, The Netherlands. Measurements included self-administered questionnaires (including the International Prostate Symptom Score), a 3-day frequency volume chart, transrectal ultrasonography of the prostate, uroflowmetry, and postvoid residual volume determination. RESULTS: The 24-hour voided volumes were independent of age (median 1506 mL; 25th to 75th percentiles 1160 to 1950). The average volume per void and functional bladder capacity (FBC, defined as the largest single voided volume) declined with advancing age. Moreover, FBC was lower in men with a reduced maximum flow rate (less than 15 mL/s) and independent of the postvoid residual volume. Multivariate analyses showed no significant effect of prostate enlargement on the FBC. FBC was strongly related to LUTS: a low FBC coincided with higher International Prostate Symptom Scores. Multivariate logistic regression analyses revealed that the presence of moderate to severe symptoms (International Prostate Symptom Score greater than 7) was independent of prostate volume, but dependent on age, a reduced flow rate, postvoid residual volume, and FBC. CONCLUSIONS: Prospective studies are needed to establish the causal relation between FBC and LUTS. Frequency volume charts are a valid, easy-to-use, noninvasive method to determine FBC as an aspect of urinary tract (dys)function in the evaluation of men with LUTS and to determine treatment options for LUTS.

Age Factors↗