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Biomedical subjects

E van der Does

Publications and source records attributed to E van der Does.

At least 19 recordsLinked to original sources
PubMed1995

Aneurysms of the abdominal aorta in older adults. The Rotterdam Study.

To assess the age- and sex-specific prevalence and risk factors for aneurysms of the abdominal aorta, the authors performed a population-based study in 5,419 subjects (42% men, 58% women) aged 55 years and over. The proximal and distal diameter of the abdominal aorta were measured by ultrasound. An aneurysm was defined as a distal aortic diameter of 35 mm or more or a dilatation of the distal part of the the abdominal aorta of 50% or more. The mean distal and proximal aortic diameter increased 0.7 mm and 0.3 mm, respectively, with every 10 years of age. In 2.1% (95% confidence interval (CI) 1.7-2.5) of the study population, an aneurysm was present, or in 4.1% (95% CI 3.2-4.9) of the men and 0.7% (95% CI 0.4-1.0) of the women. Subjects with an abdominal aneurysm were more likely to be smokers and they had higher serum cholesterol levels and higher prevalence of cardiovascular disease compared with subjects without an aneurysm. The authors conclude that the ultrasound diameter of the abdominal aorta clearly increases with age in both men and women and that the prevalence of aneurysms of the abdominal aorta in older adults in relatively high, especially in men.

Age Distribution↗
PubMed1995

Diuretics, beta-blockers, and the risk for sudden cardiac death in hypertensive patients.

OBJECTIVE: To determine whether the use of non-potassium-sparing diuretics and beta-blockers is associated with an excess risk for sudden cardiac death in hypertensive patients. DESIGN: Case-control study. SETTING: Rotterdam, the Netherlands. PATIENTS: 257 case-patients who had died suddenly while receiving drug therapy for hypertension and 257 living controls also receiving drug therapy for hypertension. MEASUREMENTS: Detailed information on medication use and clinical characteristics of all case-patients and controls was collected from the files of general practitioners. Additional information on medication use was obtained from computerized pharmacy records. RESULTS: Patients receiving non-potassium-sparing diuretics had an increased risk for sudden cardiac death (relative risk, 1.8 [95% CI, 1.0 to 3.1]) compared with a reference group treated primarily with potassium-sparing diuretics. The corresponding relative risk for beta-blocker use was 1.7 (CI, 1.1 to 2.6). The use of non-potassium-sparing diuretics without beta-blockers was associated with a higher risk for sudden death (relative risk, 2.2 [CI, 1.1 to 4.6]) than was concomitant use of non-potassium-sparing diuretics and beta-blockers (relative risk, 1.4 [CI, 0.6 to 3.0]). The risk for sudden cardiac death among recipients of non-potassium-sparing diuretics was more pronounced in those who had been receiving the diuretic for less than 1 year and in those aged 75 years or younger. CONCLUSIONS: The use of non-potassium-sparing diuretics and beta-blockers is associated with an increased risk for sudden cardiac death. This association may offset part of the mortality benefit of these drugs in the treatment of hypertension.

Adrenergic beta-Antagonists↗
PubMed1995

Interobserver agreement on iliac crest pain syndrome in general practice.

OBJECTIVE: To investigate the degree of interobserver agreement on the iliac crest pain syndrome (ICPS) in patients with nonspecific low back pain in general practice. METHODS: Sixty-one patients with nonspecific low back pain were recruited by 11 general practitioners. All patients answered a questionnaire and underwent a standard examination. Each patient was examined by 2 independent observers. RESULTS: Kappa for ICPS was 0.57 (95% CI: 0.34-0.79). For the "localized tenderness" and "typical pain" criteria, kappa was 0.57 (95% CI: 0.40-0.73) and 0.66 (95% CI: 0.48-0.83), respectively. CONCLUSION: The presence of ICPS can be judged with good interobserver agreement. Clear definition of the diagnostic criteria and examining techniques, and multiple training sessions before and during the study are prerequisites. ICPS represents a group of patients with low back pain with the same symptoms and signs. A homogeneous group facilities studies on natural history, prognosis, and therapy.

Adult↗
PubMed1995

Patient and doctor delay in acute myocardial infarction: a study in Rotterdam, The Netherlands.

BACKGROUND: Early thrombolytic therapy for patients having a myocardial infarct size and improves survival. AIM: A study was undertaken to examine the components of pre-hospital delay in patients with retrospectively proven myocardial infarction. METHOD: Data were gathered from 300 patients with a documented myocardial infarction admitted to three hospitals in Rotterdam, the Netherlands. Interviews were carried out with patients, questionnaires were given to their spouses or significant others, medical information was provided by cardiologists, and logbook information was gathered from the ambulance service. RESULTS: Half of all patients (51%) called for medical help within 30 minutes of symptom onset. General practitioners arrived within 11 minutes in half of the 257 cases to which they were called. However, in half of the 257 cases, decision making by the general practitioner before the patient was sent to a hospital took more than 82 minutes. The ambulance arrived within 15 minutes in 90% of all 242 cases, while the time required for stabilization of the patient by the ambulance staff and transport to the hospital took a median of 15 minutes. CONCLUSION: Compared with earlier studies, patients with a myocardial infarction called for help sooner. However, it may take a considerable time before the general practitioner refers the patient to hospital. Further research is needed to design measures which will improve the diagnostic power of the general practitioner in order to further reduce pre-hospital delay.

Adult↗
PubMed1992

[Functioning of an Exercise electrocardiographic service for family physicians; a report of 498 patients].

OBJECTIVE: In Rotterdam GPs have the possibility of requesting an exertion ECG for their patients from the Foundation Thrombosis Service and Physicians' Laboratory. A follow-up study was carried out in order to gain insight into the functioning of this service. PATIENTS AND METHODS: Over a period of three months, 266 GPs referred 498 patients to the service for an exertion ECG. The GPs received an enquiry form with questions on the referral and the functioning of the service. The patients were followed up for two weeks in connection with any (cardiovascular) events and with the management by the GP. An ECG was regarded as positive if the ST showed a depression greater than or equal to 1.5 mm. RESULTS: None of the patients died during the period of the investigation. Of the patients with positive and with negative ECGs, 41% and 37%, respectively, had no more complaints, 40% and 28% the same complaints, and 3% and 0.5% more complaints. Of the patients with a negative ECG (n = 439), 3.9% were referred to a cardiologist. If no ECG had been made, this proportion would have been 39%. CONCLUSION: The Foundation Thrombosis Service and Physicians' Laboratory Rotterdam provides an essential contribution to GPs' decision making concerning referral of patients with vague cardiac complaints to a cardiologist.

Adult↗
PubMed1992

Prehospital thrombolysis with alteplase (rt-PA) in acute myocardial infarction.

The improvement in survival in patients undergoing thrombolytic therapy in myocardial infarction is determined by the delay between coronary occlusion and reperfusion. The REPerfusion in Acute Infarction Rotterdam (REPAIR) study was designed to examine the feasibility and safety of prehospital thrombolysis with alteplase (rt-PA, 'Actilyse'). A small portable ECG computer system is used to confirm the presence of a large myocardial infarction (at least 1.0 mV ST-deviation) 'on the spot'. Between 22 June 1988 and 1 January 1991, 226 patients were treated by the ambulance service after the evaluation of 9052 patients complaining of chest pain. Therapy could be initiated within an average of 100 +/- 56 min (SD) after the onset of symptoms, and within 22 +/- 9 min after ambulance arrival. Three patients were defibrillated during transportation. Six patients (3%) died after arrival in the hospital. The time gained by prehospital treatment was 47 min (95% confidence limits 44-51 min) in comparison with 220 patients who did not meet the criteria for prehospital thrombolysis, but received thrombolytic therapy as soon as possible after hospital admission. The developed procedure allows rapid and safe initiation of thrombolytic therapy in selected patients, even in the absence of a physician. The observed low mortality supports the concept that prehospital thrombolytic therapy is indeed beneficial to the patient.

Adult↗
PubMed1992

Occupational reintegration of long-term cancer survivors.

To determine the long-term psychosocial consequences of cancer related to work, a postal survey was conducted among 849 long-term survivors of cancer in the southwest Netherlands. Forty-four percent of the responders who worked at the time of the diagnosis of cancer returned to their job, 24% of them part-time. Fourteen percent experienced impediments at work after return. Absenteeism in this group does not differ from that in the year prior to the moment of diagnosis. There is a small decrease in promotional and financial prospects.

Absenteeism↗
PubMed1991

Comparison of computer-aided and human review of general practitioners' management of hypertension.

Computer programs that automatically review decisions can help physicians provide better patient care. In the Netherlands, the ELIAS computer information system has replaced paper medical records in some general practices. We have written a computer program called 'HyperCritic' that audits general practitioners' management of patients with essential hypertension by taking patient-specific data from the ELIAS system. We investigated whether the computer-based medical records contain sufficient information to generate critiques, and compared the limitations of audit by hypercritic with those of review by a panel of eight physicians. Hypercritic and the physicians independently reviewed the medical records of 20 randomly selected patients with hypertension and commented on the decisions made at each of 243 patient visits. Of 468 comments on patient management, 260 were judged correct by six or more of the physicians; hypercritic also made 118 of these 260 comments. The main reasons why the program did not produce the other 142 comments were: insufficient data in the computer-based medical record; absence of sufficient medical consensus; and omissions in the database of hypercritic. Calculation of an "index of merit" ([sensitivity + specificity] - 1) for individual reviewers showed that hypercritic performed better (index of merit 0.62) in its limited domain than did physician reviewers (0.3-0.56). At least in hypertension management, automated review of computer-based medical records compares favourably with review by physicians. Further development of computer-aided clinical audit requires the introduction of computer-based medical records that capture the reasoning of physicians, and of widely accepted practice guidelines.

Adult↗
PubMed1991

Problems at social re-integration of long-term cancer survivors.

To assess the long-term consequences of cancer for everyday life, a postal survey in the Netherlands was done among 849 ex-cancer patients. Almost all responders were self-supporting to a large extent. Compared with the period before diagnosis, the socioeconomic position had not changed in 62%. 28% of the responders who were employed at the time of diagnosis (10% of all responders), were now housekeepers (99% female). Absence from work at survey did not differ significantly from absence in the year before diagnosis. A history of cancer tended to have a negative impact on promotional prospects and income. Ex-cancer patients were often confronted with problems when they tried to take out insurance or to modify an existing policy. The psychological well-being of the responders was low, compared to the average Dutch population.

Activities of Daily Living↗
PubMed1990

[Earlier treatment of acute myocardial infarction with administration of alteplase (rt-PA) before hospitalization].

The gain in survival by thrombolytic therapy in patients with myocardial infarction is determined by the delay between coronary occlusion and reperfusion. The REPAIR study was designed to examine the feasibility and safety of prehospital thrombolysis with alteplase (rt-PA, Actilyse). Indications and contraindications are verified by general practitioner or ambulance nurse with a short questionnaire. A small portable ECG computer system is used to confirm the presence of a large evolving myocardial infarction 'on the spot'. Between June 1988 and May 1990, 150 patients were treated by the ambulance service. Therapy could be initiated within an average of 91 (+/- 40) minutes (sd) after the onset of symptoms, and within 23 (+/- 9) minutes after ambulance arrival. Three patients were defibrillated during transportation, in one of these therapy had to be discontinued because of cardiac massage. No other complications were observed. Five patients (3%) died after arrival in the hospital. The time gained by prehospital treatment averaged 47 (+/- 2) minutes in comparison with 220 patients who received thrombolytic therapy after hospital admission. The procedure allows rapid and safe initiation of thrombolytic therapy in selected patients, even in the absence of a physician.

Acute Disease↗
PubMed1990

[Reliability of blood pressure measurements; comparison of an electronic meter and a mercury manometer in family practice].

The Riva-Rocci indirect method of measuring the blood pressure carries a number of sources of error. A report is presented of a study of the serviceability of an electronic blood pressure meter as compared with the conventional mercury manometer. Seventy-six paired measurements were carried out in patients selected at random using an electronic blood pressure meter and a mercury manometer meeting all Health Council requirements. The systematic error and the incidental error in both measuring procedures were compared. The differences found were so slight as to be negligible in practice. It is concluded that the electronic blood pressure meter in practice constitutes an acceptable substitute for the conventional mercury manometer.

Blood Pressure Determination↗
PubMed1990

Possibilities of continuous care. Part II.

In this article the growing need and necessity to accomplish a shift from in-patient care towards out-patient care, and the role of the hospital pharmacists after this shift has been accomplished, are discussed. If certain obstacles, which still hamper the development towards home care are overcome, then--given the hospital pharmacist's possibilities and limitations--his task in patient care, although important, seems limited. Besides, several other provisions have to be made before the hospital pharmacist comes into the picture. On the other hand, other contributions to health care in general, such as contributions to journals, helping with executing research, information to the public and participation in pharmaceutical consultation groups, have increased and are also important. Although these contributions may already have been realized, they could be more firmly structured, extended and intensified.

Delivery of Health Care↗
PubMed1980

Acute myocardial infarction: an easy diagnosis in general practice?

In the imminent myocardial infarction Rotterdam (IMIR) study, contacts by patients with their general practitioners for symptoms of potential coronary artery disease were registered. Those who had acute myocardial infarction were diagnosed on the basis of the modified World Health Organization criteria, and those with this definite diagnosis were then compared with the initial diagnosis made by the general practitioner at the moment of contact without laboratory assistance.Of the 1,343 patients included in the study, 93 (seven per cent) had ;definite' acute myocardial infarction and another 37 (three per cent) had ;possible' acute myocardial infarction according to the diagnostic criteria used.At the time of contact with the general practitioner 41 (44 per cent) of the 93 patients with definite myocardial infarction were recognized as such by the general practitioner, while in another 31 (33 per cent) the general practitioner diagnosed ;imminent' myocardial infarction.Of the 1,213 patients free of acute myocardial infarction at the time, 40 (three per cent) were incorrectly diagnosed by the general practitioner as having ;acute' myocardial infarction.In the 22 patients who in fact had acute myocardial infarction but in whom the general practitioner did not make this diagnosis at the time, it was found that there was an absence of physical signs and, similarly, in patients who subsequently did not have infarction the presence of physical signs was related to a falsepositive general practitioner diagnosis of myocardial infarction.In view of the inaccuracy of the general practitioner's provisional diagnosis of acute myocardial infarction, we believe that electrocardiogram and enzyme tests should be carried out systematically in all patients who present to general practitioners with symptoms of potential coronary artery disease. Laboratory support should be readily available and we support the idea of having a special diagnostic service.

Adult↗