PubMed Health⌕ Search

Biomedical subjects

E Schadé

Publications and source records attributed to E Schadé.

At least 19 recordsLinked to original sources
PubMed2002

Risk of depression in patients with chronic obstructive pulmonary disease and its determinants.

BACKGROUND: Although it has been repeatedly suggested that chronic obstructive pulmonary disease (COPD) is associated with depression, no conclusion has so far been reached. A study was undertaken to investigate whether depression occurs more often in patients with COPD than in controls. The demographic and clinical variables associated with depression were also determined. METHODS: Patients with a registered diagnosis of obstructive airway disease in general practice, aged > or=40 years, forced expiratory volume in 1 second (FEV(1)) <80% predicted, FEV(1) reversibility <or =12%, FEV(1)/VC < or = predicted - 1.64 x SD, and a history of smoking were selected. A random sample of subjects without a registered diagnosis of asthma or COPD aged 40 years or older acted as controls. Depression was assessed using the Centers for Epidemiologic Studies Depression (CES-D) scale. RESULTS: In patients with severe COPD (FEV(1) <50% predicted), the prevalence of depression was 25.0% compared with 17.5% in controls and 19.6% in patients with mild to moderate COPD. When the results were adjusted for demographic variables and comorbidity, the risk for depression was 2.5 times greater for patients with severe COPD than for controls (OR 2.5, 95% CI 1.2 to 5.4). In patients with mild to moderate COPD this increased risk of depression was not seen. Living alone, reversibility of FEV(1) % predicted, respiratory symptoms and physical impairment were significantly associated with the scores on the CES-D scale. CONCLUSION: Patients with severe COPD are at increased risk of developing depression. The results of this study underscore the importance of reducing symptoms and improving physical functioning in patients with COPD.

Adult↗
PubMed2001

Prevalence of comorbidity in patients with a chronic airway obstruction and controls over the age of 40.

The goal of this study is to determine the prevalence of 23 common diseases in subjects with a chronic airway obstruction and in controls. All subjects with a known diagnosis by their general practitioner of asthma or chronic obstructive pulmonary disease (COPD), and who were 40 years and older were selected (n = 1145). Subjects who were willing to participate (n = 591) and who appeared to have an irreversible airway obstruction (n = 290) were included. To recruit controls, a random sample was taken of 676 individuals who were 40 years and older and who were not diagnosed as having asthma or COPD by their general practitioner. Of these 676 individuals 421 were willing to participate. The presence of diseases was determined by using a questionnaire. One hundred and ninety-four subjects (73%) and 229 controls (63%) were shown to be suffering from one or more (other) diseases. In both groups, locomotive diseases, high blood pressure, insomnia and heart disease were most common. Locomotive diseases, insomnia, sinusitis, migraine, depression, stomach or duodenal ulcers and cancer were significantly more common in the subject group than in the control group. For both clinical and research purposes, it is important to consider the presence of diseases in patients with a chronic airway obstruction.

Adult↗
PubMed2001

Added value of co-morbidity in predicting health-related quality of life in COPD patients.

The extent to which a chronic obstructive pulmonary disease (COPD) patient is impaired in health-related quality of life (HRQoL) is only to a small extent reflected in clinical and demographical measures. As the influence of comorbidity on HRQoL is less clear, we investigated the added value of 23 common diseases in predicting HRQoL in COPD patients with mild to severe airways obstruction. COPD patients from general practice who appeared to have an forced expiratory volume in 1 sec/inspiratory vital capacity (FEV1/IVC) < predicted -1.64 SD, FEV1 <80% predicted, FEV1 reversibility < 12% and a smoking history, were included (n=163). HRQoL was assessed with the short-form-36 (SF-36) and the presence of comorbidity was determined by a questionnaire, which asked for 23 common diseases. All domains of the SF-36 were best predicted by the presence of three or more co-morbid diseases. FEV1 % predicted, dyspnoea and the presence of one or two diseases were second-best predictors. Co-morbidity explained an additional part of the variance in HRQoL, particularly for emotional functioning (delta R2=0.11). When individual diseases were investigated, only insomnia appeared to be related to HRQoL. As HRQoL is still only partly explained, co-morbidity and other patient characteristics do not clearly distinguish between COPD patients with severe impairments in HRQoL and COPD patients with minor or no impairments in HRQoL. Therefore, it remains important to ask for problems in daily functioning and well-being, rather than to rely on patient characteristics alone.

Adult↗
PubMed2000

Assessment of the need for palliative care as perceived by individual cancer patients and their families: a review of instruments for improving patient participation in palliative care.

BACKGROUND: Palliative care should fit the needs of individual cancer patients and their families. Instruments can help to improve needs assessment. This review evaluates questionnaires for the systematic assessment of needs experienced by individual cancer patients for help, care, or support, as well as the needs of their family members. METHODS: The MEDLINE and PsycLIT data bases were searched systematically. Questionnaires were evaluated by reviewing their contents and estimating their validity, reliability, and feasibility for use in caregiving practice. RESULTS: Analysis of the 471 articles identified from the searches yielded 9 questionnaires for the assessment of patients' needs and 6 questionnaires for the assessment of family members' needs. Most of these instruments were carefully constructed; their validity and reliability were satisfactory and well documented. However, in most questionnaires the needs for care were confounded by satisfaction with care, and the problems experienced by patients. Only one questionnaire for patients specifically addressed the need for help; none for family members was so specific. Data on the feasibility of questionnaires for use in regular care were scarce. Issues frequently omitted were spiritual issues, the personal needs of family members, and the continuity of care. CONCLUSIONS: None of the instruments the authors found was complete for all dimensions of palliative care. Most instruments were constructed for research purposes and had not been tested for use in practical care. Further development of practical instruments based on a theoretical concept of needs assessment seems necessary. The feasibility of instruments for use in practical caregiving and their effects on the quality of care needs further research.

Family↗
PubMed1997

[Intra- and extramural workshop for care, teaching, and research].

Medical care and its development, education, training and research are closely linked in academic medical centres. Traditionally, hospital-based disciplines can make use of the university hospital as a 'workshop' for the combination of these activities. In the Netherlands, however, there is no structurally financed workshop for the non-hospital based medical disciplines, such as family medicine, public health medicine, and nursing home medicine. In the Academic Medical Centre, University of Amsterdam, an integrated hospital and primary health care oriented academic workshop is being developed, for all medical disciplines, including social medicine (e.g. preventive care) and general practice.

Academic Medical Centers↗
PubMed1997

Methodologic issues in effectiveness research on palliative cancer care: a systematic review.

BACKGROUND: The objective of this report is to explore methodologic issues on the basis of a systematic review of the literature of effectiveness research on palliative cancer care with regard to selection and characteristics of a study population, interventions, and outcome assessment. METHODS: A systematic review was performed of randomized clinical trials on comprehensive palliative care with quality assessment of the studies by three independent observers, using predefined quality criteria. RESULTS: In the literature search, 11 relevant studies were identified. Without exception, methodologic problems were experienced. In two studies, the problems were so severe that no results were reported. Problems were associated with the recruitment of a study population in 10 studies, its homogeneity in six, patient attrition in four, defining and maintaining the contrast between the strategies in six, and selection of the outcome variables in four. CONCLUSION: Effectiveness research in palliative care is complex and has many pitfalls. To enhance the quality of future palliative care trials and the validity of their results, we particularly stress the importance of careful case finding, strict eligibility criteria, precise documentation of the process of care, and comprehensive outcome measurement. The relation of structure, process, and outcome variables in comprehensive palliative care should be further explored. It is a challenge for future research to link patient outcomes to the quality of care, independent from the autonomous course of the disease and from personal characteristics.

Combined Modality Therapy↗
PubMed1991

Role of the general practitioner in breast cancer screening in The Netherlands.

Following the advice of the Dutch National Health Council, a national screening program for breast cancer was started in 1990 in the Netherlands. All women aged 50-70 will be invited for screening by mammography in fixed or (semi)mobile screening units every 2 years. The role of the general practitioner in screening for breast cancer is described in the Dutch protocol (Standard) published in 1990 by the Dutch College of General Practitioners. Because of the role of the general practitioner/family doctor as a gatekeeper and because of the list system, every Dutch woman is known by her own general practitioner. In any given year the general practitioner will see 70% of his population. So the general practitioner is in the position to play an important role in practice and patient-centered support of breast cancer screening. The general practitioner also has an important role in the support of women with positive results. The general practitioner receives the "abnormal" results and has to explain to the woman what this means and what further investigations are necessary. There are teaching programs on screening for breast cancer for the vocational training of general practitioners and for postgraduate training.

Aged↗
PubMed1989

Oncology as part of the vocational training of general practitioners in The Netherlands.

In 1986 an educational program in Oncology for General Practitioners was developed at the University of Amsterdam. This program will be implemented within the general practitioners' vocational training. In this program the various goals of the general practitioner have been categorized: prevention; diagnosis by the general practitioner; diagnosis by the specialist; therapy; and guidance and care. All these goals have been further subdivided in more concrete skills to give form to the various aspects of the task of the general practitioner. These skills have been related to the different types of cancer. A number of related skills will be illustrated in the program for a specific type of tumor. Hence, a so-called basic educational program is formed. The various basic educational programs, in which different types of tumors are used for illustration, consist of program-units of 90 minutes. Relevant aspects of specific types of malignancy, which are not dealt with in the basic educational program, will be added to the basic educational program as supplements.

Curriculum↗