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Biomedical subjects

F S van Dam

Publications and source records attributed to F S van Dam.

At least 37 records · Page 2Linked to original sources
PubMed1998

Impact of diarrhoea and faecal incontinence on the daily life of HIV-infected patients.

Diarrhoea in HIV-1 infected persons is an important clinical problem. To improve care and counselling, information about the way, and the extent to which, diarrhoea influences the daily life of these patients can be useful. A cross-sectional descriptive study was performed at the HIV infection clinic of three major hospitals in Amsterdam. A diary, the Coates card system (to determine the relative severity of the symptoms) and an interview were used as outcome measures. Sixty-two patients participated and were classified into four groups: group 1 (minor diarrhoea, n = 26), group 2 (mild diarrhoea, n = 18), group 3 (moderate diarrhoea, n = 7) and group 4 (severe diarrhoea, n = 11). Diarrhoea was considered a very severe symptom in groups 2, 3 and 4. Even mild diarrhoea may have a debilitating impact on the day-to-day life of HIV-infected patients. Faecal incontinence occurs frequently. Patients can worry about their diarrhoea because of lack of information. Patients who do not have diarrhoea according to current definitions of it, consider diarrhoea to be equally problematic as those with (moderate) diarrhoea. More information on prognosis and practical solutions for patients are recommended.

Activities of Daily Living↗
PubMed1996

A study of the reliability, validity and responsiveness of the HIV overview of problems evaluation system (HOPES) in assessing the quality of life of patients with AIDS and symptomatic HIV infection.

The objective of this study was to evaluate the feasibility, reliability, validity and responsiveness of the HIV Overview of Problems Evaluation System (HOPES) in a Dutch sample. The HOPES was administered three times in a one-year period to a sample of 106 outpatients with a symptomatic HIV-infection (n = 23) or AIDS (n = 83). The HOPES is a self-report HIV-specific quality of life (QOL) questionnaire including five scales: physical, psycho-social and sexual functioning, medical interaction and partner relationship. QOL was also assessed with the EORTC Quality of Life Questionnaire (EORTC QLQ-C30), a 30-item self-report instrument. Clinical data included Centers for Disease Control and Prevention (CDC) stage, date of diagnosis and CD4 cell count. Patients needed approximately 20-30 minutes to complete the questionnaire. The five scales had good internal consistency reliability. Multitrait scaling analysis provided moderate support for item discriminant and convergent validity. The HOPES exhibited adequate levels of construct validity: (1) the inter-scale correlations and correlations with the EORTC QLQ-C30 were in the predicted direction; (2) it discriminated clearly between patients with AIDS and ARC and (3) it was able to document changes in QOL over time. Moreover, the HOPES was responsive to changes in clinical status over time as indicated by CD4 counts. This study provides further evidence of the reliability and validity of the HOPES and shows that this instrument is responsive to changes in CD4 cell counts.

AIDS-Related Complex↗
PubMed1996

The Amsterdam Preoperative Anxiety and Information Scale (APAIS)

The purpose of the present study was to assess patients' anxiety level and information requirement in the preoperative phase. During routine preoperative screening, 320 patients were asked to assess their anxiety and information requirement on a six-item questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Two hundred patients also completed Spielberger's State-Trait Anxiety Inventory (STAI-State). Patients were able to complete the questionnaire in less than 2 min. On factor analysis, two factors emerged clearly: anxiety and the need for information. The anxiety scale correlated highly (0.74) with the STAI-State. It emerged that 32% of the patients could be considered as "anxiety cases" and over 80% of patients have a positive attitude toward receiving information. Moreover, results demonstrated that 1) women were more anxious that men; 2) patients with a high information requirement also had a high level of anxiety; 3) patients who had never undergone an operation had a higher information requirement than those who had. The APAIS can provide anesthesiologists with a valid, reliable, and easily applicable instrument for assessing the level of patients' preoperative anxiety and the need for information.

Adolescent↗
PubMed1996

Telephone-based nursing intervention improves the effectiveness of the informed consent process in cancer clinical trials.

PURPOSE: Here we report the results of a randomized study undertaken to test the efficacy of a supplementary, telephone-based nursing intervention in increasing patients' awareness and understanding of the clinical trials in which they are asked to participate. METHODS: During a 12-month period, 180 cancer patients who were approached to participate in a phase II or III clinical trial were randomized to undergo either of the following: (1) standard informed consent procedures based on verbal explanations from the treating physician plus written information (controls); or (2) standard informed consent procedures plus a supplementary, telephone-based contact with an oncology nurse (intervention). For purposes of evaluation, face-to-face interviews were conducted with all patients approximately 1 week after the informed consent process had been completed. RESULTS: The two groups were comparable with regard to sociodemographic and clinical variables. Both groups had a high level of awareness of the diagnosis and of the nature and objectives of the proposed treatments. The intervention group was significantly (P < .01) better informed about the following: (1) the risks and side effects of treatment; (2) the clinical trial context of the treatment; (3) the objectives of the clinical trial; (4) where relevant, the use of randomization in allocating treatment; (5) the availability of alternative treatments; (6) the voluntary nature of participation; and (7) the right to withdraw from the clinical trial. The intervention did not have any significant effect on patients' anxiety levels or on rates of clinical trial participation. Patients reported high levels of satisfaction with the intervention. CONCLUSION: The use of a supplementary, telephone-based nursing intervention is a feasible and effective means to increase cancer patients' awareness and understanding of the salient issues that surround the clinical trials in which they are asked to participate.

Adult↗
PubMed1995

Health-related quality-of-life evaluation in HIV-infected patients. A review of the literature.

This article presents a review of the literature on health-related quality-of-life (HRQOL) measurements in HIV-infected patients by means of multidimensional self-report questionnaires. Since 1989, 11 HRQOL instruments have been used, the most frequently employed scales and items being derived from the Medical Outcomes Study. The 9 instruments that were evaluated for their internal consistency reliability and validity generally met the conventional levels of psychometric performance. Descriptive longitudinal and psychometric studies that examined the ability of HRQOL instruments to distinguish between diagnostic groups consistently showed that, over time, patients developed more symptoms and reported poorer physical, role and sexual functioning. Patients' psychological functioning improved or remained at approximately the same level. Despite some methodological limitations, the 4 HRQOL studies performed as part of clinical trials provided valuable information for both patients and doctors about the impact of treatment with zidovudine, interferon-alpha or epoetin (recombinant human erythropoietin) on patients' HRQOL. Future studies are needed that provide more information on the feasibility, stability and responsiveness of existing HRQOL instruments. In addition, future studies should focus on the natural history of HRQOL in HIV-infected patients, and on the impact of commonly prescribed prophylactic and antiretroviral drugs on patients' HRQOL. There is an urgent need for translations and cultural adaptations of HRQOL instruments for use in different HIV-infected populations, including women, children, intravenous drug users and patients from African and other developing countries.

HIV Infections↗
PubMed1994

[Alternative treatments in cancer; extent and background of utilization].

OBJECTIVE: To determine the prevalence of use of alternative cancer therapies, as well as the characteristics of the patients who use these therapies, and their experiences with them. DESIGN: Descriptive study. SETTING: Outpatient departments of several hospitals in North-Holland. METHOD: In total, 1091 patients were asked to participate in the study; 949 patients agreed (87%): 535 women (56%) and 414 men, with an average age of 62 years. The sample was stratified by diagnosis: 233 breast, 183 lung, 278 stomach/colon cancer and 255 patients with various other cancer diagnoses. A structured face-to-face interview and several written questionnaires were used. RESULTS: 2XOf the 949 patients, 9.4% were currently using an alternative therapy in addition to conventional treatment, and 5.8% had used an alternative treatment in the past but had subsequently stopped. Patients using alternative therapies were relatively younger and more highly educated than patients who chose not to use these therapies. Use of alternative therapies was more frequent among patients undergoing palliative treatment and patients who were actively dealing with the problems surrounding their disease. Only a minority of the patients believed they could be cured by the alternative therapy; the majority hoped it would help to slow the progression of their disease or strengthen their resistance. CONCLUSION: The motivation for seeking alternative treatment more often appears to be fear and uncertainty rather than belief in the efficacy of the treatment. For many patients the use of alternative therapies represents a means of dealing with the anxiety and stress surrounding their disease.

Adult↗
PubMed1993

Longitudinal study on the Quality of Life of symptomatic HIV-infected patients in a trial of zidovudine versus zidovudine and interferon-alpha.

OBJECTIVES: To compare the effect of treatment with zidovudine (ZDV) or a combination of ZDV and interferon-alpha (IFN-alpha) on patient Quality-of-Life (QoL); and to document changes over time in QoL. DESIGN: This study is part of a longitudinal, randomized, controlled clinical trial comparing the efficacy and tolerance of ZDV monotherapy and ZDV plus IFN-alpha. Patients were followed-up for 1 year. SETTING: Seven academic or general medical hospitals. PARTICIPANTS: Thirty-six symptomatic HIV-infected patients (Centers for Disease Control and Prevention stage IV) with a CD4+ count > or = 150 x 10(6)/l and Karnofsky Performance Status score > or = 60, who had not received ZDV or IFN-alpha before. METHODS: QoL was assessed using two self-report questionnaires (the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire and an AIDS-specific questionnaire), administered before and every 3 months after the start of the treatment. RESULTS: There were no significant differences in QoL between the two treatment groups over a 1-year period. Emotional, cognitive and social functioning improved in the entire group, and patients reported fewer symptoms (for example, shortness of breath, nausea and vomiting, influenza-like symptoms, diarrhoea, lack of appetite, taste disturbances, dizziness, weight loss, trouble in vision) and a better overall QoL until month 9. Thereafter, emotional, cognitive and social functioning and overall QoL deteriorated and patients reported more symptoms. Major complaints at baseline and follow-up were associated with fatigue and emotional functioning: patients reported a strong need to rest, and felt very tired, worried, tense and irritable. CONCLUSIONS: These results show that both treatments may have a temporary beneficial effect on patient QoL. QoL research may contribute to evaluation of clinical trials and provide patients with information about the effects of treatment on their QoL, thus enabling them to make informed decisions.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Recollections of general anaesthesia: a survey of anaesthesiological practice.

In order to identify the factors to which patients attach importance when undergoing general anaesthesia, 678 patients were retrospectively asked about their recollections of previous anaesthetics during routine preoperative screening over a period of 14 months. The most frequently mentioned recollections concerned the post-anaesthetic period, followed by recollections of the induction of anaesthesia. From the post-anaesthetic period, nausea/vomiting and drowsiness were most often cited. The number of anaesthetics previously undergone had no influence on the reports of the two most frequently mentioned complaints. The rate of nausea/vomiting in this series was 21.0%. The number of patients reporting nausea/vomiting following an anaesthetic has not changed over the years. The last 250 patients were asked to assess the quality of their anaesthetics on a 5-point scale. More than a quarter of the patients were not satisfied with the anaesthesia. No correlation was found between the assessment of the anaesthesia and complaints about nausea/vomiting and drowsiness. The possible role of psychological factors in the origin of complaints about anaesthesia is discussed.

Adolescent↗
PubMed1992

Totally implantable venous access ports--the patients' point of view. A quality control study.

After implanting > 150 totally implantable venous catheters, 40 patients were interviewed about their experiences by telephone using a standard questionnaire. There were 25 women and 15 men, all having or having had chemotherapy for nonresectable advanced cancer, 26 of them by means of a portable pump. Almost all patients thought that the advantages of the Port-a-Cath (PAC) outweighed its disadvantages; they were not hindered in their daily activities, and none of the patients experienced problems with sexual intercourse because of the PAC. Drawbacks of the method are that 40% of the patients found the operation for insertion of the PAC to be more painful than they had expected. Although PAC reduced the fear of repeated peripheral vein puncture, puncture of the PAC was viewed as painful by 15 of the 40 patients. We conclude that a PAC seems to be preferable to an external catheter but that pre- and postoperative patient information needs to be improved.

Adult↗
PubMed1991

The effect of age on treatment choice and survival in elderly breast cancer patients.

To investigate the effect of age on treatment choice and survival in patients with breast cancer, data from the cancer registry of the Netherlands Cancer Institute (NKI, Amsterdam, The Netherlands) on 611 women have been analyzed. All patients 55 years and older admitted to the NKI for primary treatment of breast cancer between 1981 and 1986 were selected. For women 75 years and older, physicians were less likely to use treatment of adjuvant radiation therapy after a mastectomy and more often employed primary hormonal therapy only for local stage disease than for younger patients. Life-table analysis showed that disease-specific survival at 7 years for patients 65 through 74 years of age was significantly better (65%) than that of the youngest (55%) and the oldest age group (50%). In multivariate regression analysis (Cox), age older than 74 years was significantly and independently associated with a shorter disease-specific survival as compared with patients younger than 75 years. This difference in survival, however, does not seem to be the result of the difference in treatment between the age groups, but suggests an influence of age-related factors such as comorbid diseases and weak physical condition, which manifest themselves most strongly in the oldest age category and make the older woman more vulnerable to the course of malignant disease.

Age Factors↗
PubMed1991

The effect of supportive pamidronate treatment on aspects of quality of life of patients with advanced breast cancer.

Selective aspects of quality of life during supportive pamidronate (APD) treatment were assessed in breast cancer patients with osteolytic metastases. 144 patients were randomised to a pamidronate group (n = 76) or a control group (n = 68). A questionnaire measuring mobility impairment, bone pain, fatigue and gastrointestinal toxicity was administered at 3-monthly intervals. The analysis focused on changes in these quality of life domains over time. The median follow-up for both groups was 18 months. Mobility impairment and bone pain were significantly less in the pamidronate group as compared with the control group, due primarily to a rapid improvement shortly after initiation of pamidronate treatment. Thereafter, a gradual increase in these symptoms was noted in both groups. Gastrointestinal complaints and fatigue levels were similar over time in the two groups, suggesting that these symptoms are more dependent on disease-related events and cytotoxic treatment than on pamidronate treatment. The results indicate that reduced skeletal morbidity in breast cancer patients during pamidronate treatments is associated with an improvement in selective aspects of quality of life.

Activities of Daily Living↗
PubMed1990

A 14-year investigation into the workload of oncology nurses in The Netherlands Cancer Institute.

In the Netherlands Cancer Institute, the daily workload of nurses has been measured since 1976. Each day the head nurse ranks the patients into one of the seven categories of care requirements. It can be inferred from the data that the percentage of patients who need intensive nursing care has doubled from 30% in 1976 to more than 60% in 1989. The increase in the nursing staff has only partially kept abreast of the increase in the workload. In addition to this simple technique, a more refined "factor evaluation system" has been developed. On the basis of this method, a more detailed check can be made as to what connection there is between the characteristics of the patient, the particular disease and treatment on the one hand, and the nursing workload on the other. Because of this it is possible to assess and to predict the consequences for nursing care when a new therapy is introduced. The correlation between both assessment methods is good: 0.72. A plea is made to use both methods of assessment in conjunction: the simple method for assessing the daily workload, and the refined and thus more laborious method to analyze the factors responsible for changes in the workload. In view of the rapid dissemination of new oncological therapies, it is essential that international consensus be reached with regard to a method for measuring the workload of nurses. In this way the consequences of these new therapies for the workload of nurses might be known more rapidly and proper measures could be taken.

Cancer Care Facilities↗
PubMed1989

Pain experience and pain management among hospitalized cancer patients. A clinical study.

This study examines the nature, pattern, and consequences of pain experienced by cancer patients, both during hospitalization and during the immediate posthospitalization period. Of the 240 hospitalized cancer patients screened, 45% were found to be in pain. Although 59% of these patients had found ways to reduce their pain, nearly one third reported being seriously limited in their daily activities. Sleep disorder and mood disturbance also were related to the experience of pain. Applied pain management strategies were rated by two physicians as inadequate in 54% of cases. The most frequent recommendation for improved pain management was an increase in the dosage or a change in the class of analgesics. The importance of periodic assessment of pain and its consequences, both physical and psychological, is discussed in light of increasing the level of information available to physicians and patients regarding appropriate approaches to pain management.

Adult↗