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Biomedical subjects

Dirk Devroey

Publications and source records attributed to Dirk Devroey.

15 recordsLinked to original sources
PubMed2006

Early detection of COPD: a case finding study in general practice.

OBJECTIVES: To estimate the prevalence of undiagnosed chronic obstructive pulmonary disease (COPD) in a population of general practice patients at risk for developing COPD. A further aim was to evaluate the presence of respiratory symptoms as a predictor for the diagnosis of COPD. METHODS: This study was conducted by eight general practitioners (GP) in six semi-rural general practices. During two consecutive months all patients attending their GP were included if they met the following criteria: current smokers between 40 and 70 yr of age, and a smoking history of at least 15 pack-years. A questionnaire regarding smoking history, respiratory symptoms, exposure to dust or chemical fumes, and history of respiratory diseases was completed for all patients. Subjects without known COPD were invited for spirometric testing. RESULTS: Off the 146 general practice patients included, 17.1% already had an established COPD diagnosis. Screening by spirometry revealed a 46.6% prevalence of COPD. Underdiagnosis of COPD was more frequent in the younger age categories (40-49 Yr; 50-59 Yr). Objective wheezing was the only sign that was significantly more frequent in COPD patients than in non-COPD patients (P<0.001). Patients with previously known COPD were significantly older, and complained more of chronic cough and fatigue than newly detected patients. CONCLUSION: Almost half of a general practice population of current smokers between 40 and 70 years of age, with a smoking history of at least 15 pack-years, was diagnosed with COPD, and roughly two thirds of these were newly detected as a result of the case finding programme.

Adult↗
PubMed2005

The benefit of fibrates in the treatment of 'bad HDL-C responders to statins'.

BACKGROUND: Lowering high levels of low-density lipoprotein cholesterol (LDL-C) is the primary aim in the prevention of cardiac events. However, low levels of high-density lipoprotein cholesterol (HDL-C) are also associated with an increased risk of ischemic heart disease. Some patients have lower HDL-C during statin treatment than before the treatment. These patients were first described in 2002 as 'bad HDL-C responders to statins'. The aim of this study was to describe the benefit of fibrates in monotherapy for these patients. METHODS: A cross-sectional survey of lipid levels, cardiovascular disease and risk factors in outpatients treated for dyslipidemia. For this study we analyzed the lipid levels, drug treatment and medical history for 14 patients with low HDL-C (<40 mg/dl) during statin treatment and ever treated with fibrates. RESULTS: Total cholesterol (TC) and LDL-C were respectively 8% and 6% higher with fibrates compared to statins. Mean HDL-C was 49% higher during fibrate treatment and TC to HDL-C and LDL-C to HDL-C were respectively 26% and 27% lower with fibrates. CONCLUSIONS: Patients with low levels of HDL-C during statin treatment had far better levels for HDL-C, TC to HDL-C and LDL-C to HDL-C with fibrates in monotherapy. For bad HDL-C responders to statins with low or normal LDL-C treatment with fibrates instead of statins should be considered. For those with high LDL-C fibrates should be added to statins. A randomized double-blind crossover trial with simvastatin and fenofibrate has been initiated to corroborate these findings.

Adult↗
PubMed2004

A review of the treatment guidelines on the management of low levels of high-density lipoprotein cholesterol.

This paper aims to review the guidelines on the importance given to high-density lipoprotein cholesterol (HDL-C) as a risk factor or as threshold and target level in the treatment of dyslipidemia. We developed a strategy with cholesterol-related key words to search for guidelines in the major databases. The Appraisal of Guidelines Research Evaluation (AGREE) instrument was used for the evaluation and inclusion of the guidelines. In total nine guidelines were selected. Almost all selected guidelines consider low HDL-C as a marker of an increased risk for coronary heart disease. However, only few guidelines use the level of HDL-C as a threshold or target level for the treatment of dyslipidemia. The guidelines provide only little information on the management of patients with treatment-induced low HDL-C. Instead of using total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) we consider the use of the ratios of TC to HDL-C or LDL-C to HDL-C as a threshold as well as a target for treatment.

Cholesterol, HDL↗
PubMed2004

Correlations between lipid levels and age, gender, glycemia, obesity, diabetes, and smoking.

A low level of high-density lipoprotein cholesterol (HDL-C) is an important cardiovascular risk factor. Dietary measures and pharmacological agents are often not sufficient to reach the HDL-C target level of 40 mg/dl in patients with low baseline HDL-C. This study assesses the association between lipid levels and age, gender, body mass index (BMI), glycemia, diabetes and smoking and focuses on the parameters influencing HDL-C. In the town of Lede (Belgium) all patients aged between 45 and 64 years were invited during 1999 for a free of charge health check-up and blood test. Blood pressure, weight, length and smoking habits were recorded. Serum levels for glycemia and lipoproteins were determined. In total, 629 subjects attended for the check-up. In a logistic regression analysis age above 50 years was correlated with low HDL-C (OR = 2.27 CI = 1.10-4.68). Male gender was correlated with low HDL-C (OR = 3.85 CI = 1.77-8.43) and with high triglycerides (TG) (OR = 1.94 CI = 1.14-3.30). From the level of 90 mg/dl glycemia was correlated with low HDL-C (OR = 2.56 CI = 1.02-6.39) and high TG (OR = 2.12 CI = 1.16-4.06). Obesity was correlated with low HDL-C (OR = 2.36 CI = 1.18-4.71) and high TG (OR = 2.17 CI = 1.88-5.23). This study provides some evidence to sharpen the target levels for glycemia and BMI among patients with low HDL-C and high TG. For these patients, the target glycemia should be around 90 mg/dl and BMI around 25 kg/m2. Physical activity and diet are also important in the achievement of these target levels.

Aged↗
PubMed2004

An 8 year nationwide prospective registration of non-consented HIV testing in Belgium.

BACKGROUND: Little information is available on the number of HIV tests that are carried out without the patient's consent. The aim of this study was to find out about the number of HIV tests for which the specific consent of the patient was not obtained and to describe the circumstances in which these tests were carried out. METHODS: Since 1993 a representative network of sentinel general practitioners (GPs) has recorded data about requests for HIV tests, risk behaviour and the patient's awareness about the test. RESULTS: In total 11,660 HIV tests were recorded and for 3628 tests the question about patient awareness was completed. Although non-consensual HIV testing (NHT) is against European guidelines on informed consent, 453 tests were performed without informed consent. Of the 292 participating GPs, 17.5 per cent never completed the question about the patient's awareness and 35.6 per cent performed at least one non-consensual HIV test. For 28.9 per cent of NHT, no risk behaviour for HIV infection was identified and for 43.4 per cent the risk behaviour was unknown. NHT was recurrent for patients with suggestive symptoms (22.7 per cent), patients consulting for a check-up (21.1 per cent) and women consulting for antenatal care (12.8 per cent). CONCLUSION: Never before have figures been available about NHT forthcoming from a prospective registration including such a large number of tested subjects. Physicians should be reminded once more about the unacceptability of NHT. Instead of performing a non-consensual HIV test, physicians should invest more time in pre-test counselling, especially in those patients with a higher risk or with suggestive symptoms for HIV.

AIDS Serodiagnosis↗
PubMed2003

Registration of stroke through the Belgian sentinel network and factors influencing stroke mortality.

INTRODUCTION: Stroke is one of the leading causes of death. Belgian stroke mortality rates are only available from the death certificates notification. OBJECTIVES: To estimate stroke incidence, mortality and case fatality, to compare our figures with those available from the death certificates notification and from neighboring countries, and identifying factors influencing survival. METHODS: A nationwide prospective registration by 178 Belgian general practitioners recording all cerebrovascular events in 1998-1999. All events, including those for which medical care was immediately found in hospital, were included. RESULTS: The yearly age-and-gender-adjusted stroke attack rates were estimated at 185 cases per 100,000 inhabitants (95% CI = 169-202). After 12 months, 47% of the patients died, resulting in an estimated yearly stroke mortality rate of 88 per 100,000 inhabitants (95% CI = 73-105). The case fatality rate among men (39%; 95% CI = 29-51) was lower than among women (50%; 95% CI = 39-63) (p < 0.05). In a forward stepwise logistic regression diabetes, stroke history, hemorrhagic stroke, coma, swallow deficit and urinary incontinence had a negative influence on stroke survival. Treated hypertension had a beneficial effect on survival. CONCLUSIONS: Stroke mortality rates estimated by the sentinel practices are fairly comparable with those based on the death certificates notification. The stroke attack rates correspond with those of neighboring countries. The role of treated hypertension on the outcome of strokes remains controversial in this registration.

Age Distribution↗
PubMed2003

Serum lipid comparison in patients treated by statins or fibrates: existence of bad HDL-C responders to statins.

INTRODUCTION: Major cardiac events are strongly associated with high levels of low-density lipoprotein cholesterol (LDL-C) and low levels of high-density lipoprotein cholesterol (HDL-C). The HDL-C target level (40 mg/dl) is often not achieved with statins. The aim of this study was to compare the proportions of patients achieving the HDL-C target levels after one year of treatment with statins or fibrates. Furthermore, a subgroup with low HDL-C levels during statin treatment was investigated and suggestions are made for a better management of these patients. METHODS: A survey of lipid levels, cardiovascular disease and risk factors in 120 outpatients treated with a statin or a fibrate for hyperlipidaemia (total cholesterol (TC) > 250 mg/dl or triglycerides (TG) > 200 mg/dl after diet). After one year of treatment the proportions of patients achieving the target levels for TC, LDL-C, HDL-C,TG,TC/HDL-C and LDL-C/HDL-C are compared for statins and fibrates. RESULTS: The proportions of patients achieving the target lipid levels with statins or fibrates are comparable except for HDL-C. Compared to the baseline, the proportion of patients achieving the HDL-C target level of 40 mg/dl increases only by 8.3% for statins and by 42.9% for fibrates. In total, 38.5% of the statin group had low HDL-C-levels after one year of treatment. Among these patients, eight were treated with a fibrate before the statin and six were treated with a fibrate afterwards. In those 14 patients, mean HDL-C increased during fibrate treatment by 48.5% and TC/HDL-C and LDL-C/HDL-C decreased by 25.7 and 26.5%, respectively as compared with statins. CONCLUSIONS: Patients with low levels of HDL-C during statin treatment had far better levels of HDL-C, TC/HDL-C and LDL-C/HDL-C with fibrates. A randomised double-blind crossover trial with simvastatin and fenofibrate has been initiated to corroborate these findings.

Adult↗
PubMed2002

Do general practitioners use what's in their doctor's bag?

OBJECTIVE: To find out what general practitioners (GPs) take with them on house calls and how frequently they use it? DESIGN: A questionnaire about the drugs and medical equipment used during house calls. SETTING: Two peer review groups of GPs in Overijse and Hoeilaart (Belgium). SUBJECTS: 29 GPs. MEAN OUTCOME MEASURES: Availability and use of drugs and medical equipment on house calls. RESULTS: All GPs had a stethoscope, a sphygmomanometer, an otoscope and sterile injection syringes at their disposal on house calls and they used them frequently. Only 57% took a blood glucose sensor with them and 25% took the medical records on home visits. Though only 50% always carried all of the most common emergency drugs with them, almost 100% of GPs had administered all of them in the previous 12 months. Only epinephrine and atropine were not frequently administered. CONCLUSION: Most of the GPs were sufficiently equipped to meet most situations that can occur during house visits and emergency calls. Most of the available drugs and equipment were used during the 12 months preceding the registration. Only the medical records and a blood glucose sensor were insufficiently available.

Belgium↗
PubMed2002

How are patients informed about their HIV test results?

BACKGROUND: AIDS and HIV are hot topics in public health nowadays, but little information is available about the way in which HIV test results are communicated to patients. OBJECTIVE: Our aim was to find out about the way in which patients are informed about their HIV test results and the delay they experience. METHOD: Since 1996, a representative network of sentinel GPs has recorded data about requests for HIV tests, risk factors and the way in which and the delay with which patients are informed about their HIV test results. RESULTS: Between 1996 and 1999, 4807 requests for an HIV test were recorded. Test results were given mostly by phone (41.9%). Patients at risk were informed more often during a planned follow-up. Anxious patients were informed more often about the results by phone, and in 61.2% test results were communicated during the first week following the test. Results were given earlier if patients were anxious or had themselves asked for the test. Although non-consensual HIV testing is against the European guidelines on informed consent, 102 tests (2.2%) were performed without informed consent. CONCLUSIONS: Even though notification by phone decreases the delay, physicians should be encouraged to make follow-up appointments to inform the patient about the test results. A face-to-face conversation is the only way in which physicians can offer valuable post-test counselling. Physicians should be informed about the unlawfulness of non-consensual HIV testing.

Belgium↗
PubMed2002

A "bad responder" to statins.

We report the case of a man whose high-density lipoprotein cholesterol (HDL-C) and the ratios of total cholesterol to HDL-C and low-density lipoprotein cholesterol to HDL-C worsened dramatically during pravastatin treatment. After 3 years, pravastatin was replaced by fenofibrate. The result was spectacular. The HDL-C increased to at least twice the level obtained during pravastatin.

Anticholesteremic Agents↗
PubMed2002

The added value of the registration of home accidents in general practice.

OBJECTIVES: To determine the number, the nature and the circumstances of home accidents managed in general practices, and to compare the results with the European Home and Leisure Accidents Surveillance System (EHLASS) data. DESIGN: A prospective population survey of all domestic accidents managed in 138 sentinel general practices during 1995/96. SETTING: Primary health care. SUBJECTS: In total, 4481 patients were included, of which 58% were female. MAIN OUTCOME MEASURES: The incidence of domestic accidents managed in general practices; the nature and place of the accident; the nature of the injury; the predisposing factors and related products. RESULTS: The highest incidence of home accidents was measured among children and the elderly. The median age was significantly lower for men (36 years) than for women (54 years). Among women, 74% of all home accidents were the result of a fall. The lesion is often a contusion or wound. Fractures were recorded in 20% of all home accidents. Three-quarters of all fractures involved women, especially older women. Most accidents among women (80%) occurred during motion and housework. Among men, 65% of all home injuries occurred during motion and do-it-yourself jobs. CONCLUSION: Because of the close relation with most patients and a knowledge of their living conditions, the GP is able to provide more reliable information on the circumstances of accidents than are health care providers in hospitals. The prevention of home accidents should at least partly be based on the results provided by general practitioners.

Accidents, Home↗
PubMed2002

The incidence of stroke and transient ischaemic attacks is falling: a report from the Belgian sentinel stations.

BACKGROUND: Increasing as well as decreasing trends in stroke incidence have been described. AIM: To examine time trends associated with the incidence of stroke and transient ischaemic attacks (TIAs) within an ongoing registration network. DESIGN OF STUDY: Analysis of data from a network of sentinel practices. SETTING: Sentinel practice population (approximately 1.4% of the total Belgian population. METHOD: Attack incidence rates of both stroke and TIA were studied at four one-year registration periods between 1984 and 1999. RESULTS: The number of events identified as stroke was 1097 (513 in males and 584 in females). The percentage of first-ever stroke was 69%, 64%, and 70% in 1989, 1998, and 1999 respectively. The number of events identified as TIAs was 382 (165 in males and 217 in females). The percentage of first-ever TIA was 65%, 69%, and 75% in 1989, 1998, and 1999 respectively. Yearly age-standardised attack rates of stroke significantly decreased during the registration period from 2.86 per 1000 in 1984, to 1.62 per 1000 in 1999 (chi2 for trend, P = 0.04) in males and from 2.97 per 1000 to 1.96 per 1000 (P = 0.007) for females. The decrease was restricted to subjects aged over 60 years. For TIA, a significant decrease (P = 0.014) was identified in females, but not in males (P = 0.61). Crude attack rates of stroke also significantly decreased, with an overall decrease between 1984 and 1999 of 37% in males and 26% in females. No such trend was found for TIA (P = 0. 63 for males and P = 0.35 for females). CONCLUSION: Both crude and age-standardised attack rates of stroke show a clear and significant decrease between 1984 and 1999. For TIA, a weaker trend was identified.

Aged↗