Biomedical subjects

A Smidts

Publications and source records attributed to A Smidts.

4 recordsLinked to original sources

PubMed2004

Validity of conjoint analysis to study clinical decision making in elderly patients with aortic stenosis.

OBJECTIVE: Written case simulations are increasingly being used to investigate clinical decision making. Our study was designed to determine the validity of written case simulations within a conjoint analysis approach. STUDY DESIGN AND SETTING: We developed a series of 32 written case simulations that differed with respect to nine clinical characteristics. These case simulations represented elderly patients with aortic stenosis. The clinical characteristics varied according to a fractional factorial design. We analyzed retrospectively all consecutive patients of 70 years of age or older with an aortic stenosis in three university hospitals. RESULTS: 34 cardiologists from three Dutch hospitals gave their treatment advice to each of these case simulations on a six-point scale (ranging from 'certainly no' to 'certainly yes' to surgical treatment). We compared the influence that the clinical characteristics had on the responses to these case simulations with their influence on the actual treatment decision for 147 actual patients in the same three hospitals. We found a strong agreement. This agreement was only slightly affected by the cut-off value used to dichotomize the treatment advice into a recommendation in favor of or against surgical treatment. CONCLUSION: Written case simulations reflect well how clinicians are influenced by specific clinical characteristics of their patients.

Aged↗

PubMed2001

Variability in treatment advice for elderly patients with aortic stenosis: a nationwide survey in The Netherlands.

OBJECTIVE: To determine how the decisions of Dutch cardiologists on surgical treatment for aortic stenosis were influenced by the patient's age, cardiac signs and symptoms, and comorbidity; and to identify groups of cardiologists whose responses to these clinical characteristics were similar. DESIGN: A questionnaire was produced asking cardiologists to indicate on a six point scale whether they would advise cardiac surgery for each of 32 case vignettes describing 10 clinical characteristics. SETTING: Nationwide postal survey among all 530 cardiologists in the Netherlands. RESULTS: 52% of the cardiologists responded. There was wide variability in the cardiologists' advice for the individual case vignettes. Six groups of cardiologists explained 60% of the variance. The age of the patient was most important for 41% of the cardiologists; among these, 50% had a high and 50% a low inclination to advise surgery. A further 24% were influenced equally by the patient's age and by the severity of the aortic stenosis and its effect on left ventricular function; among these, 62% had a high and 38% a low inclination to advise surgery. Finally, 23% of the cardiologists were mainly influenced by the left ventricular function and 12% by the aortic valve area. The presence of comorbidity always played a minor role. CONCLUSIONS: There were systematic differences among groups of cardiologists in their inclination to advise aortic valve replacement for elderly patients, as well as in the way their advice was influenced by the patients' characteristics. These results indicate the need for prospective studies to identify the best treatment for elderly patients according to their clinical profile.

Adult↗

PubMed1990

[Empirical study of the market orientation of veterinarians in The Netherlands].

Linked to the theoretical framework of marketing in the veterinary practice, as explained in Schuurmans and Smidts (1) pp. 1-10 and Schuurmans and Smidts (2), an empirical research project has been undertaken. This research gives insight into the extent to which practices base their services on a marketing orientation. By means of telephone inquiries among a sample of 166 veterinarians, this was investigated. The research shows that veterinarians think more in a product-oriented way than in a market-oriented way, and they do not use all the opportunities a marketing orientation could bring to their services. This expresses itself, among others by not using market segmentation, by the inadequate use of the marketing mix elements communication and distribution, and by the fact that the opportunities of the marketing information system are hardly applied. By means of further research in individual practices it might be possible to give concrete advise fit for that practice. Research among the clients of the veterinarians might, beside many other kinds of research, also give valuable insights.

Economic Competition↗

PubMed1990

[Marketing in veterinary practice; a theoretical framework].

An increase in the number of veterinarians, while at the same time the number of animals has remained constant, has resulted in growing competition. By extending the range of products and by enlarging the veterinarians' scope of activities this competition can be decreased. A marketing-orientation will be helpful in this respect. This article indicates in which way marketing concepts can be used in a veterinary practice. The services of the veterinarian will be looked at by means of the Abell approach. This focuses on the functions performed by the services and examines, per function performed, for whom this might be interesting and which alternatives there might be. Next the concept of market segmentation is filled in for a veterinary practice by means of a hypothetical example. The marketing mix (product, place, price, promotion and personnel) is given considerable attention. The last element of marketing in a veterinary practice that is discussed here is the marketing information system. In a next article the question will be answered how marketing-directed the Dutch veterinarian works nowadays. To find this out research has been done; 166 vets were interviewed by telephone for approximately 40 minutes each.

Economic Competition↗