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B Aertgeerts

Publications and source records attributed to B Aertgeerts.

At least 19 recordsLinked to original sources
PubMed2006

['Evidence-based medicine' in the Dutch and Flemish psychiatric, psychological and psychotherapeutic specialist literature: widely used?].

The expression 'evidence-based medicine' was first used in medical journals in the 1990's. Recent research has shown that the expression appears very frequently in international medical publications. Until recently, however, there were no research data concerning the frequency with which the expression is used in the titles and summaries in Dutch and Flemish specialist journals in the field of psychiatry, psychology and psychotherapy. In our systematic review of the Dutch and Flemish specialist medical literature published between 1990 and 2003 we found that the use of the expression increased markedly as from 1997.

Belgium↗
PubMed2005

[Evidence-based medicine: a discussion of the most frequently occurring criticisms].

Since the introduction of evidence-based medicine (EBM) into the field of health care in the early nineties some major criticisms have appeared in scientific literature. One of the most commonly heard objections to EBM is loss of therapeutic freedom. However even with the advent of EBM the physician continues to look for solutions that are tailored to the patient. The available evidence is often inadequate, there are many inconsistencies and contradictions in the research material and the published outcomes are distorted by publication bias. There is resistance to the opinion that randomized clinical trials (RCTs) provide the best foundations on which to build clinical policies. There must always be room for views expressed in other types of study. EBM is primarily for academics and does not take clinical expertise into account. However as the results of scientific research are becoming increasingly available to a wider public, patients are able to challenge the decisions made by their health-care practitioners and push them to provide the motivation for their decisions. Many health-care practitioners have commented that they always have to take the results of scientific research into account. One strength of EBM in this is the transparent manner in which the overview of the literature develops and the systematic approach to results from scientific study. After all, there is insufficient evidence that the EBM process works effectively and that it therefore improves patient care. It is true to say that patients who receive treatment of which the efficacy has been proven experience better treatment results than other patients. Setting up a definitive randomized study to answer this question would be difficult if not impossible. EBM is an aid to support clinical decision making. The development of principles on which to base this way of thinking and acting and the quest for suitable research designs and the most objective research results in order to be able to answer all the questions posed by caregivers, is not yet complete. EBM is just one of the weapons in the armoury of the caregiver in the battle for the optimal provision.

Decision Making↗
PubMed2005

[From PICO to search terms on the Internet: how to find relevant information? New coxibs: do they have a better gastrointestinal safety?].

In the first article of this series, we have shown how to translate a clinical problem into a well built question, by creating a PICO (Patient--Intervention--Comparison--Outcome). In this second article, we will explain how to transform the PICO in English search terms for use on the internet. We use these terms in the different databases to find the answer to the following clinical problem: "In patients aged 65 or over with hip osteoarthritis, and a history of peptic ulcer, is the risk of a new peptic ulcer less using a cox-2 inhibitor than with a classic nonsteroidal anti-inflammatory drug?"

Aged↗
PubMed2005

Measuring the body temperature: how accurate is the Tempa Dot?

INTRODUCTION: We evaluated the accuracy of a disposable, sterile thermometer that is practical in use and holds no risk of cross-infections. METHODS: a cross-sectional study was set up in which we compared the Tempa Dot with the mercury thermometer in adults and children. Subjects were recruited from general practice and a paediatric ward. The mercury thermometer was used orally in subjects over 2 years of age and rectally in children up to 2 years old. The Tempa Dot was used either orally or axillary. RESULTS: The total population consisted of 212 patients, of which 131 children were younger than 16 years old. Their mean age was 17.3 years old, ranging from 1 month to 76 years. The mean difference between the mercury thermometer and the Tempa Dot, used orally or axillary, was 0.04 degrees C. For children between 0 and 16 years old, the mean difference was 0.08 degrees C. Agreement between the two methods as assessed with regression analysis and Bland and Altman plots was very good. ROC curve analysis suggests cut-off points of 37.2 and 37.6 degrees C to detect fever for the Tempa Dot at the oral and the axillary site respectively. Sensitivity and specificity were 100.0% and 79.0% for the total population, measuring orally and 100.0% and 95.9% axillary. In children, sensitivity and specificity were 100.0% and 83.1% orally, and 100.0% and 95.4% axillary. Using a single cut-off point for both measuring sites, namely 37.5 degrees C, sensitivity dropped and specificity increased for the oral site. For the axillary site, sensitivity remained unchanged and specificity was somewhat less. CONCLUSION: the Tempa Dot is a reliable alternative for the mercury thermometer. In clinical use, a cut-off point of 37.5 degrees C for both the oral and axillary site is most appropriate.

Adolescent↗
PubMed2005

[Pharmacological treatment of hypercholesterolaemia in primary prevention. The use of the different sources of information].

In the first two articles of this series devoted to Evidence-Based Medicine, we have shown how to translate a clinical problem in a well formulated question and how to derive search terms from the PICO. In this article, we describe in more detail the different sources of information and how to use them. The strategy will be illustrated by answering the question whether it should be recommended to treat hypercholesterolaemia in a young woman without cardiovascular risk factors. In a following article, we will show how to adapt a search strategy to a specific question or PICO.

Adult↗
PubMed2005

[Systemic validation of clinical practice guidelines: the AGREE network].

INTRODUCTION: Over recent decades, the number of available clinical practice guidelines has enormously grown. Guidelines should meet specific quality criteria to ensure good quality. There is a growing need for the developement of a set of criteria to ensure that potential biases inherent in guideline development have been properly addressed and that the recommendations for practice are valid and reliable. AIM: The AGREE-collaboration is an international network that developed an instrument to critically appraise the methodological quality of guidelines. AGREE promotes a clear strategy to produce, disseminate and evaluate guidelines of high quality. METHOD: In the first phase of the international project the AGREE-instrument was tested in 11 different countries. Based on this experience the instrument was refined and optimised. In the second phase it was disseminated, promoted and evaluated in 18 participating countries. Belgium was one of them. RESULTS: The Belgian partner in the AGREE-project developed 3 workshops and established 13 validation committees to validate guidelines from Belgian developer groups. We collected 33 questionnaires from participants of the workshops and the validation committees, in which we asked for primary experiences and information on the usefulness and applicability of the instrument. We were also interested in the shortcomings of the instrument and potential strategies to bridge them. DISCUSSION: More efforts should be made to train methodological experts to gain certain skills for a critical appraisal of clinical practice guidelines. Promoting the AGREE-instrument will lead to a broader knowledge and use of quality criteria in guideline development and appraisal. CONCLUSION: The development and dissemination of an international list of criteria to appraise the quality of guidelines will stimulate the development of methodologically sound guidelines. International comparisons between existing guidelines will lead to a better collaboration between guideline developers throughout the world.

Canada↗
PubMed2004

CUGE: a screening instrument for alcohol abuse and dependence in students.

OBJECTIVES: The prevalence of alcohol abuse on college campuses ranges from 7 to 17%. Frequent heavy drinkers place themselves and others at risk for a variety of adverse consequences and frequently remain undetected. Brief individual interventions result in a significant reduction on the number of drinks. Therefore, detection of students at risk is useful and desirable. The CUGE has been elsewhere described as a promising screening device for problem drinking in students. In order to determine the diagnostic value of this new questionnaire, we set up a validation study in a new and independent population of freshmen. METHODS: A cross-sectional diagnostic study. Participants were college freshmen of the Katholieke Universiteit Leuven. All students received a questionnaire, containing the CUGE, being the test of interest, and the CIDI as the reference test. RESULTS: The CUGE combines a very high sensitivity of 91% with a reasonable specificity of 76.3% in this validation group. CONCLUSIONS: The CUGE is an excellent screening device in this population of students. In addition, it is a short questionnaire with only yes or no questions. This makes the CUGE easily applicable as a part of broad routine questionnaires.

Adult↗
PubMed2004

The value of the CAGE in screening for alcohol abuse and alcohol dependence in general clinical populations: a diagnostic meta-analysis.

OBJECTIVE: To perform a meta-analysis to assess diagnostic characteristics of the CAGE in screening for alcohol abuse or dependence in a general clinical population and to test a new method for pooling of ROC curves. METHODS: Medline search performed over the period 1/1/1974 to 31/12/2001. MEASUREMENT: Calculation of diagnostic values. RESULTS: We identified 35 articles using the DSM criteria as the gold standard to test the diagnostic value of the CAGE. Only 10 studies could be included for the meta-analysis. With a cutoff point > or =2, the pooled sensitivity is far better in inpatients (0.87) than in primary care patients (0.71) or ambulatory patients (0.60). The pooled specificity also differs for each group. The likelihood ratios seem to be relatively constant over the populations (overall LR+:3.44;LR-:0.18). We calculated a pooled AUC of 0.87 (95% CI 0.85-0.89). At low specificity values, the sensitivity was homogeneous over the studies, and at a low sensitivity, the specificity was heterogeneous. CONCLUSION: The diagnostic value of the CAGE is of limited value using this test for screening purposes at his recommended cutpoint of > or =2.

Alcoholism↗
PubMed2004

Disclosing the diagnosis of dementia: the performance of Flemish general practitioners.

BACKGROUND: This issue of whether or not, how and when patients should be told of the diagnosis of dementia remains a matter for discussion. Recent data confirm that the patient is told of the diagnosis in only 40 to 55% of cases. We therefore studied the performance of Flemish general practitioners (GPs) in this area. METHOD: A postal questionnaire, based on that prepared by Johnson et al., was sent to a random sample of 1000 Flemish GPs, out of a total of 7000. RESULTS: A total of 647 answers were returned, of which 521 were eligible for analysis (response rate 60%). Thirty-six percent of these 521 GPs always or usually disclose the diagnosis, while 37% provide information about the prognosis. Most doctors (75%) see benefits in disclosure, particularly as regards planning care, providing treatment and encouraging a good doctor-patient relationship. Only 61% of respondents present an appropriate differential diagnosis. DISCUSSION: The results obtained from the Flemish GPs are similar to those of other known studies. A detailed analysis of the reasons for and the benefits of disclosing the diagnosis reveal a less reluctant attitude than could be inferred from the rough data. GPs pay a great deal of attention to the patient's feelings, experiences and ability to cope and to the proper timing of their information. However, intensive educational projects have to be set up in order to stimulate a more etiologically-oriented diagnosis and to improve the quality of the process of disclosing the diagnosis of dementia.

Attitude of Health Personnel↗
PubMed2004

The diagnostic value of IADL evaluation in the detection of dementia in general practice.

It is assumed that general practitioners can make an important contribution to the diagnosis of dementia. One of the used strategies comprises an evaluation of the Instrumental Activities of Daily Living (IADL). There are contradictory data on the value of this strategy. During one month, 21 Flemish general practitioners evaluated the IADL capacities of all subjects older than 65 years with whom they had contact. Subjects with dementia and/or living in a residential home for the elderly were excluded. Housing and living conditions, medication use and IADL were registered. The general practitioner formulated a clinical evaluation. All subjects with an IADL score > or = 1 and a random sample from the group IADL = 0 underwent a Mini Mental State Examination. Subjects with an IADL score = 4 were referred for neuropsychological and specialist examination. The average age of the 1003 registered subjects was 75.1 years (SD = 6.8). A large majority of them (85%) were totally independent. There was a large discrepancy between the family's and the patient's judgment on the presence of memory problems. There was an inverse correlation between the IADL and MMSE: when the IADL score increased, the MMSE score fell. The diagnostic value of the IADL for the diagnosis of dementia with Camdex-N as a reference standard could not be evaluated because the number of tested subjects was too small. Against the MMSE, sensitivity was 0.81 (SE = 0.03), and specificity was 0.48 (SE = 0.05). The evaluation of the IADL activities had some drawbacks as a detection method for dementia but the use of IADL data may still be clinically valuable in general practice. The correlation between the general practitioner's judgment and that of the specialist was very good. This study showed that the use of the IADL score might change the general practitioner's diagnostic judgment. Furthermore this study confirms the existence of a major threshold for the referral to a specialist of patients with suspected dementia by general practitioners.

Activities of Daily Living↗
PubMed2004

Screening for alcohol abuse and dependence in older people using DSM criteria: a review.

Alcohol abuse and dependence in older people are important problems, which frequently remain undetected by health services. Therefore, screening instruments for alcohol abuse and dependence in elderly people would be useful in clinical practice. To assess the quality of screening instruments we performed a literature search in Medline (1966-2002) and PsycINFO (1967-2002). Seven research reports were found. The MAST-G and especially the CAGE appear appropriate. The two questions of Cyr and Wartman, AUDIT and the MAST do not appear appropriate in screening for alcohol abuse and dependence in elderly people in a clinical environment.

Aged↗
PubMed2004

[EBM: otitis media in children: how to formulate a PICO question].

This series of articles begins with a problem frequently encountered in children: acute otitis media. Under the insistence of parents, antibiotics are frequently prescribed. The physician knows that the value of that therapy is debatable, but what for a child of 6 years of age? The physician whishes to compare his/her opinion with what is published in the litterature or available on the web. How to start his/her research? In this first article the physician will find out how to translate his/her practical question into a question which leads to a practical answer, and then to a PICO question. This will allow the physician to find sources of directly usable and relevant data which will offer a rational and wellfounded answer to his/her clinical question.

Child↗
PubMed2001

Screening properties of questionnaires and laboratory tests for the detection of alcohol abuse or dependence in a general practice population.

BACKGROUND: Early identification of alcohol abuse or dependence is important in general practice because many diseases are influenced by alcohol. General practitioners, however, fail to recognise most patients with alcohol problems. AIM: To assess the diagnostic performance of the CAGE and AUDIT questionnaires, their derivatives, and laboratory tests in screening for alcohol abuse or dependence in a primary care population (male and female patients), attending their general practitioner (GP). DESIGN OF STUDY: A diagnostic cross-sectional study. SETTING: A random sample of patients who were over 18 years of age (n = 1992) attending 69 general practices situated in the same region in Belgium. METHOD: Alcohol questionnaires (CIDI 1.1, section I, CAGE, AUDIT, AUDIT-C, Five-Shot, and AUDIT Piccinelli) were completed, demographic information was recorded, and patients underwent conventional blood tests, including mean corpuscular volume, liver function tests, the gamma-glutamyl transferase test, and carbohydrate-deficient transferrin (CDT, estimated using %CDT). Calculations of sensitivity, specificity, positive predictive value, negative predictive value, odds ratios with their 95% CIs, and receiver operating characteristic (ROC) curves for different scores of the questionnaires and laboratory tests, using DSM-III-R as the reference standard. RESULTS: The past-year prevalence of alcohol abuse or dependence in this population was 8.9% (178/1992) of which there were 132 male and 45 female patients attending a general practice. The GPs identified 33.5% of patients with alcohol abuse or dependence. Among male patients, all questionnaires had reasonable sensitivities between 68% and 93% and hence at lower cut-points than recommended. Only the sensitivity of the CAGE, even at its lowest cut-point of > or = 1 was lower (62%). In female patients the sensitivities were lower; however, odds ratios were higher for different questionnaires. The receiver operating characteristic (ROC) curves did not differ between the questionnaires. The laboratory tests had low diagnostic accuracy with areas under the ROC curves (AUCs) between 0.60 and 0.67 for female patients and 0.57 and 0.65 for male patients. CONCLUSIONS: This is one of the largest known studies on alcohol abuse or dependence among family care practices. We confirm earlier results that the AUDIT questionnaire seems equally appropriate for males and females; however, screening properties among male patients are higher. Nevertheless, the Five-Shot questionnaire is shorter and easier to use in a general practice setting and has nearly the same diagnostic properties in male and female general practice patient populations. We confirm that conventional laboratory tests are of no use for detecting alcohol abuse or dependence in a primary care setting. Also, the %CDT cannot been used as a screening instrument in this general practice population.

Alcoholism↗
PubMed2000

The value of CAGE, CUGE, and AUDIT in screening for alcohol abuse and dependence among college freshmen.

BACKGROUND: This study attempted to (1) determine the prevalence of alcohol problems in college freshmen, (2) assess the performance of both the CAGE and the Alcohol Use Disorders Identification Test (AUDIT) questionnaires in this population, and (3) assess the possibility of improving the CAGE and/or AUDIT. METHODS: A sample of 3564 consecutive college freshmen, with a mean age of 18 years, at the Catholic University of Leuven, (Belgium) completed, during a cross-sectional study, a questionnaire assessing drinking behavior and identifying students at risk as defined by DSM-IV criteria. The questionnaire also included the CAGE questionnaire and the AUDIT. Calculations of sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratios, and receiver operating characteristic curves for different scores of the CAGE and the AUDIT were performed, using DSM-IV criteria as the reference standard. RESULTS: The area under the receiver operating characteristic curve of the CAGE and the AUDIT was 0.76 and 0.85, respectively. The cutoff score of 1 for the CAGE was associated with a sensitivity of 42%, a specificity of 87%, a positive predictive value of 36%, and a negative predictive value of 90%. A score of 6 or more for the AUDIT gave a sensitivity of 80%, a specificity of 78%, a positive predictive value of 37%, and a negative predictive value of 77%. These results were related with a prevalence of 14.1% of alcohol problems. Replacing one question of the CAGE by "often driving under the influence" resulted in the CUGE (acronym for "cut down, under influence, guilty feelings, and eye opener"), with an area under the curve of 0.96, a positive likelihood ratio of 8.7, and a negative likelihood ratio of 0.04. CONCLUSIONS: Prevalence of alcohol problems in college students is confirmed to be high. When screening for alcohol problems in a college freshmen population, one question seems extremely important. The newly constructed CUGE questionnaire may improve screening efforts in students, compared with existing questionnaires.

Adolescent↗
PubMed2000

Is there a difference between CAGE interviews and written CAGE questionnaires?

BACKGROUND: The CAGE questionnaire is a frequently studied and used instrument for screening of alcohol problems. It was developed and tested as a written questionnaire, but, clinically, it is often used as an oral interview. No comparisons have been made between the results of a written and an oral CAGE. This study attempted to (1) compare the results of a written CAGE questionnaire and a CAGE interview, and (2) compare the efficiency of using a simple open-ended question about drinking habits before asking the CAGE and asking the CAGE without an introduction. METHODS: All patients who attended a general internal medicine, cardiology, or hepatology clinic were classified according to the week of the consultation, as follows: group I (week 1), patients completed a written CAGE and were subsequently interviewed during a normal consultation by a physician, who also asked the CAGE questions; group II (week 2), a physician first interviewed the patients, including the CAGE, and subsequently patients completed a written CAGE; and group III (week 3), patients completed a CAGE interview after an open-ended introduction ("What do you drink during the day?"). Kappa values were used to compare the answers of the written and oral CAGE interviews (groups II and I). Nonparametric ANOVA was used to compare the results of group III and the oral interview of group II. RESULTS: Mean age was comparable between the groups, gender ratio was comparable between groups I and III, but there were fewer males in group II. Comparison of all written CAGEs with the oral CAGEs in the same patients resulted in an accuracy of 0.91 and a kappa value of 0.75 (95% CI, 0.66-0.84). No significant difference could be found between the results of the oral CAGE with or without an open-ended introduction (p = 0.46). CONCLUSIONS: We found no difference between the oral and the written versions of the CAGE. This is important because most research results originate from written questionnaires. Our results do not support the finding that a different approach to the CAGE questions results in an increasing number of patients in which alcohol problems were detected.

Adult↗