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Biomedical subjects

C Spreeuwenberg

Publications and source records attributed to C Spreeuwenberg.

At least 19 recordsLinked to original sources
PubMed1997

Diet or diuretic? Treatment of newly diagnosed mild to moderate hypertension in the elderly.

The aim of this study was to assess the effectivity of dietary measures in the treatment of hypertension. Therefore, a single-blind randomised clinical trial was carried out in elderly persons with recently diagnosed hypertension. Patients were recruited from a general practice (6555 persons) during visits or after written invitation or invitation by phone. New hypertensive patients (with measurements taken on three different occasions >159 mm Hg systolic and/or >94 mm Hg diastolic), aged 60-80 years, without target-organ damage, dementia, diabetes mellitus or malignant disease entered a 3-month intervention programme of either intensive dietary counselling, receiving a sodium-reduced (<100 mmol/24h), potassium-enriched (>75 mmol/24h), and weight-reducing diet (BMI <25), or only 25 mg chlorthalidone a day. Forty-two newly diagnosed hypertensive subjects met the inclusion criteria. Two dropped out from the chlorthalidone group, one with side effects and another after a myocardial infarction. Although blood pressure (BP) in the diet group decreased less than in the drug group, of the patients in the diet group 45% fell back to a normal systolic and 50% to a normal diastolic BP (drug treatment group, systolic 75% and diastolic 85%). In contrast with the diet group, lipid spectrum and blood glucose concentration in the diuretic group, however, deteriorated slightly. The dietary intervention was effective in elderly patients with a systolic or diastolic BP in the range of 160-180 and 95-100 mm Hg, respectively. Reduction in weight should be the primary aim. It is argued that sodium reduction can be achieved better by collective measures. In patients with a BP of more than 180 mm Hg systolic or 100 mm Hg diastolic, dietary advice and drug treatment should be combined.

Aged↗
PubMed1997

The reform of hospital care in the Netherlands.

OBJECTIVES: This article provides a short overview of the structure of hospital care in the Netherlands. It discusses a number of hospital reform programs that have been started since the early 1980s and others more recently proposed. Attention has also been given to the potential impact of hospital reform. METHODS: Descriptions of hospital structure, planning, financing, payment of medical specialists, and hospital workforce and services provide a context for a discussion of current hospital reform programs. Trends in hospital care delivery, strategic management, and internal organization are examined. RESULTS: The relationships between the hospital and other health-care providers, health insurers, employers, and patients are found to have a significant impact on the future of the hospital. The interconnections of these four factors will help form the basis for an understanding of ongoing hospital change. CONCLUSIONS: Hospital care has been subject to rapid change during the last two decades, as hospitals become centers for acute specialized medical care. This development has important consequences for the position of hospitals in the health-care delivery network, as they become one of a number of providers in a more integrated delivery system. It should be noted that the changes in hospital care cannot be understood as the results of a single reform program, but rather as the result of a long series of reform efforts.

Economics, Medical↗
PubMed1992

[The use of drugs for euthanasia and assisted suicide in family practice].

An exploratory, descriptive, retrospective study was carried out concerning the use of means for euthanasia or assisted suicide, primarily regarding the period 1986-1989. Data were collected via an anonymous written inquiry among a random sample of family physicians in North Holland (n = 521) and family physicians in the rest of the Netherlands (n = 521). The inquiry contained among others questions about the last case they had encountered. In addition, police reports of euthanasia or assisted suicide administered by family physicians in North Holland (n = 263) were analysed. The response to the inquiry was 67%; (non-respondents did not differ from respondents): 388 cases could be analysed. The use of euthanatics by family physicians in North Holland and those in the rest of the Netherlands was identical. More than 40 different euthanatics were used, most of them incidentally. The most frequently used (combination of) means were a benzodiazepine with a neuromuscular relaxant (23%), a barbiturate with a neuromuscular relaxant (20%), barbiturates (15%) and opioids (12%). Most euthanatics were given intravenously (61%, of which 5% by infusion), orally 21%, intramuscularly 12%, rectally 3% and subcutaneously 2%. The quantities applied varied greatly. The average length of time from the start of the procedure till decrease was 3.8 hours (less than or equal to 1 minute-72 hours). In 12% of the cases complications or unintended effects were reported. Comparison of inquiry and police reports showed some differences.(ABSTRACT TRUNCATED AT 250 WORDS)

Barbiturates↗
PubMed1992

Euthanasia and assisted suicide. I. How often is it practised by family doctors in The Netherlands?

A survey was conducted among family doctors to determine the frequency with which they were requested to administer euthanasia or assist in suicide, and how often they actually applied these procedures. Two random samples (in each n = 521) were taken from the population of Dutch family doctors (n = 6300) and requested to complete an anonymous questionnaire. The response was 67%. The entire body of Dutch family doctors practices euthanasia or assisted suicide about 2000 times per annum; 48% have never engaged in these practices. An average of 40% of all requests are complied with. We conclude that far fewer family doctors are involved in euthanasia and assisted suicide than was previously supposed. Euthanasia or assisted suicide was administered to 1 in 25 persons who died in their own homes.

Communication↗
PubMed1992

Euthanasia and assisted suicide. II. Do Dutch family doctors act prudently?

We conducted a survey among two random samples of Dutch doctors in order to determine whether they acted prudently with regard to euthanasia and assisted suicide. The doctors completed an anonymous questionnaire and those who at one time or another had applied euthanasia or assisted suicide (52%) were asked about several aspects of the requirements for prudent practice. 'Pointless suffering' was the most important and most common reason for requesting euthanasia or assisted suicide; 'pain' was rarely the most important reason. In 7% of the cases alternative forms of treatment were still available; these were hardly ever therapeutic. A total of 12% of the doctors had applied euthanasia or assisted suicide without having had any kind of consultation or discussion with a colleague, a nurse or any other health care professional; 26% had not issued a certificate testifying to death from natural causes. We conclude that some of the family doctors do not observe the procedural requirements, but that the majority satisfies the material requirements for prudent practice.

Clinical Protocols↗
PubMed1991

[Euthanasia and assisted suicide by physicians in the home situation. I. Diagnoses, age and sex of patients].

In order to map out morbidity, age and sex of patients with whom family doctors participated in euthanasia or assisted suicide, an exploratory, descriptive, retrospective study was carried out primarily regarding the period 1986-1989. Data were collected via an anonymous written injury among an at random sample of family doctors in North Holland (n = 521), and family doctors in the rest of the Netherlands (n = 521). In addition, police reports of euthanasia/assisted suicide administered by family doctors in North Holland (n = 263) were analysed. The inquiry included among others questions about the last case doctors had encountered. Diagnoses were classified according to the ICD-9. The results were compared with compiled mortality data relating to persons who died in their own homes. Correlations and differences were analysed by means of the chi2-test. The response to the inquiry was 67% (non-responders did not otherwise differ from responders): 228 (North Holland), 160 (rest of the Netherlands) and 263 (police reports) cases could be analysed. Of the patients, 85% suffered from a malignant neoplasm. The average age at which euthanasia or assisted suicide was practised was 63.4 years (men) and 66.1 years (women). Under the age of 30 and above 85 euthanasia or assisted suicide was administered only rarely. Proportionally these procedures were applied to the same extent to men as to women. In about 20% of the cases an important secondary diagnosis was present. In conclusion, it is especially the malignant neoplasms that cause such suffering that euthanasia or assisted suicide are practised. The average age at which they are applied is considerably lower than that of the total of people who die in their own homes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Euthanasia and assisted suicide by physicians in the home situation. 2. Suffering of the patients].

In order to assess the suffering of patients who died at home and with whom family doctors participated in euthanasia or assisted suicide, an exploratory, descriptive, retrospective study was carried out regarding primarily the period 1986-1989. Data were collected via anonymous written inquiry among an at random sample of family doctors in North Holland (n = 521), and family doctors in the rest of the Netherlands (n = 521). With reference to the last case of euthanasia or assisted suicide they had encountered questions were included about physical and emotional suffering, signs and symptoms and life expectation. Correlations and differences were analysed by means of the chi2-test. The response to the inquiry was 67% (non-responders did not otherwise differ from responders): 228 (North Holland), 160 (rest of the Netherlands) cases could be analysed. Most patients suffered physically as well as emotionally. The most frequently mentioned aspect was 'general weakness or tiredness'. Also 'dependence or being in need of help', loss of dignity, humiliation' and 'pain' were often present to a (very) large extent. At the time the procedure was carried out the life expectation in almost two-thirds of the cases was less than 2 weeks; in 10% of the cases it was more than 3 months. For several reasons, this investigation reduces the possibilities of extrapolation. Further investigation is necessary to determine whether this picture of suffering is specific of this category of patients.

Adult↗
PubMed1990

The association between peer consultations and three aspects of clinical competence.

The relationship between the clinical competence of general practitioners and the degree of peer consultation about diagnostic and therapeutic problems was studied. Three aspects of clinical competence are discerned: attention paid to somatic aspects, patient-orientation and risk of unnecessary harm of the management. Clinical competence has been measured by a written simulation of patient-doctor encounters using five patients and assessment procedures in a study with a correlational design. For this study 49 subjects were selected from a population of 184 GPs who completed their vocational training in general practice at the University of Utrecht between 1975 and 1980. They were selected from those who consult their colleagues frequently and systematically about a variety of patients' problems and from those who do so little or not at all. The 49 subjects did not differ from the remainder in several relevant aspects such as practice setting, subscription to medical journals, etc. The 49 GPs are relatively consistent in the quality of attention they pay to somatic aspects. The consistency with regard to the two other aspects is rather low, especially regarding the risk of unnecessary harm. Attention paid to somatic aspects is connected with patient orientation. The latter is also connected with risk of unnecessary harm, but the former is not. The three aspects are more or less separate aspects of clinical competence. Peer consultation has a direct relationship with quality of attention paid to somatic aspects; GPs who do not consult among peers anyway display a lower quality of attention to somatic aspects in comparison to those who do so.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Competence↗
PubMed1990

Do peer consultations improve quality of care in general practice?

The present study relates to three aspects of quality of care in general practice: attention paid to somatic aspects, patient orientation and risk of unnecessary harm. Quality of care had been measured by (a) a written simulation of patient-doctor encounters, which includes five patients and (b) rating procedures. The study has been carried out in two steps. Firstly several aspects of peer consultation have been investigated in a group of 184 doctors (response rate: 83%), who had their vocational training in the department of General Practice of the University of Utrecht. One third of the GPs consulted colleagues frequently and continued to do so for long periods, dealing systematically with a variety of problems, one third did so infrequently or unsystematically, and one third did little or no consulting at all. A relationship was found between the type of practice and consulting behaviour: 20% of those who practice alone never consulted peers, whereas those in group practices and health centres are accustomed to do so regularly. Secondly, 49 doctors were selected from the 184 mentioned above. The 49 did not differ from the remainder in several relevant aspects such as practice setting, subscription to medical journals, etc. Peer consultation seems to have a direct relationship with the quality of attention paid to somatic aspects; GPs who do not consult among peers in any way display a lower quality of attention to somatic aspects in comparison to the others. In this study these GPs are all solo physicians.(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Medical↗
PubMed1990

Dietary treatment of patients with mild to moderate hypertension in a general practice: a pilot intervention study (1). The first three months.

Thirty-five patients with mild to moderate hypertension were randomised into a three months' dietary advised and a three months' control group. The diet was of a composition currently considered to be appropriate, and was monitored by a dietitian. Statistically significant decreases in diastolic blood pressure, mean arterial pressure, sodium excretion, and low density lipoprotein (LDL)-cholesterol occurred in the intervention group, although differences in change between the intervention and the control group were, except for LDL-cholesterol, not statistically significant. Thus, it did not become clear whether and to what extent change in diet was responsible for the lowering of the blood pressure in the intervention group.

Adult↗
PubMed1990

Dietary treatment of patients with mild to moderate hypertension in a general practice: a pilot intervention study (2). Beyond three months.

In a general primary care practice the feasibility and the effects of dietary counselling in mild and moderate hypertension were studied for a period of 18 months. Significant decreases in blood pressure and sodium excretion compared to baseline occurred, while serum lipids showed transient improvement. Of the original 35 participants, 28 finished the study.

Adult↗
PubMed1989

Diagnostic styles of general practitioners confronted with ambiguous symptoms. An exploratory study.

This study explores the diagnostic process of general practitioners confronted with ill-defined and ambiguous complaints, which eventually appeared to be caused by a malignancy. Three aspects were rated: (a) the adequacy of the initial problem definition; (b) the carefulness of further diagnostic methods; and (c) how the suspicion of malignancy originated. These three aspects, which were strongly connected, seem to be parts of a diagnostic approach with two polar extrems: a critical style and a biased style. Characteristic of a critical style is full awareness of detail, careful observations, consideration of ambiguous symptoms, and consciousness that the correct diagnosis is often other than the one initially judged most likely. The opposite, the biased style, is characterized by little alertness for detail, less careful observations, and overinterpretation of facts supporting the initial hypotheses.

Adult↗
PubMed1988

Consultation among peers in general practice; from no consultation to peer review.

The present study concerned several aspects of peer consultation by general practitioners, investigated in a group of 184 doctors (response rate: 83%) who had their vocational training in the department of general practice of the University of Utrecht and practised for at least three years at the time of the study. Questionnaire responses indicated that consultation during and outside surgery hours and participation in case-discussion groups generally extended over more than two years, occurred frequently, and usually pertained to diverse problems associated with diagnosis and treatment. Participation in study and peer review groups extended usually over a shorter time (1 to 1 1/2 years) and the problems dealt with were predominantly the same as for individual consultation. One-third of the general practitioners consulted colleagues frequently and continued to do so for long periods, dealing systematically with a variety of problems; one-third did so infrequently or unsystematically, and one-third did little or not at all. A relationship was found between the setting of the practice and consulting behaviour: 20% of those who practised alone never consulted peers, whereas those in group practices and health centres were accustomed to do so regularly.

Family Practice↗