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Biomedical subjects

F W Smeenk

Publications and source records attributed to F W Smeenk.

At least 19 recordsLinked to original sources
PubMed2004

[Successful treatment with infliximab of a patient with refractory sarcoidosis].

A 35-year-old patient had persistent, refractory symptomatic pulmonary sarcoidosis, complicated by a rare congenital muscular disease: McArdle's disease (a glycogen storage disease caused by myophosphorylase deficiency). As the desaturations during mild exercise caused by the sarcoidosis aggravated the negative consequences of his muscle disease and he failed to respond adequately to corticosteroids and methotrexateimmunosuppressive agents, the patient was successfully treated experimentally with infliximab, a monoclonal antibody and specific tumour necrosis factor alpha (TNF-alpha) inhibitor. The results were favourable: after 17, 21 and 36 months there was an improvement in various lung function parameters, his fatigue was reduced and the patient had been able to resume his work as a taxi driver. TNF-alpha appears to be an important mediator of clinical disease in sarcoidosis and infliximab could be a promising therapy for patients with refractory sarcoidosis.

Adult↗
PubMed2000

[Management of treatment refusal by a psychiatric patient with a life-threatening infectious form of pulmonary tuberculosis].

A Somalian man aged 26 was admitted to a general hospital because of haemophthisis. A severe infectious and life threatening pulmonary tuberculosis was diagnosed. Thereafter, the patient denied having any disease, refused any therapy or diagnostic procedure and wanted to leave the hospital. He was isolated by virtue of the Wet Bestrijding Infectieziekten ('WBI': Bill on Management of Infectious Diseases). Permission for treatment without consent was arranged by virtue of the Wet op de Geneeskundige Behandelingsovereenkomst ('WGBO': Decree on the Medical Contract). The use of measures like fixation and involuntary administration of medication could also be arranged by virtue of the WGBO. The Wet Bijzondere Opnemingen Psychiatrische Ziekenhuizen ('Wet BOPZ': Bill on Compulsory Admission to Psychiatric Hospitals), which exclusively concerns involuntary treatment exclusively of psychiatrics patients, was of no value in this case. Analysis of the different aspects of these three laws led to the conclusion that in case of a somatic disease, whether or not complicated by a psychiatric diagnosis, a treatment without consent must be arranged by virtue of the WGBO.

Adult↗
PubMed2000

Effects of transmural care on coordination and continuity of care.

Although health care in The Netherlands is of a high quality with strong emphasis on primary care and high accessibility to hospital care, care deficits may arise in patients with chronic complex health problems who need the attention of several caregivers. Because no regular coordinating centre or person exists, coordination of care may be deficient leading to a poor continuity of care. This may be particularly true for those patients being cared for by both primary and hospital care teams, as is the case for most terminal cancer patients. Therefore, a transmural home care intervention programme for terminal cancer patients was introduced which intended to optimize coordination of care and thereby improve continuity of care. This quasi-experimental study investigated the effects of this intervention (intervention group 79 patients) on indicators of coordination and continuity of care. When compared to standard care (control group 37 patients) moderate positive effects (mainly for the nursing disciplines) on the various indicators of coordination and continuity of care by the transmural home care intervention programme were found. Future prospective studies are needed to further elucidate the effects of transmural care on these aspects of care.

Continuity of Patient Care↗
PubMed1998

Effectiveness of home care programmes for patients with incurable cancer on their quality of life and time spent in hospital: systematic review.

OBJECTIVE: To investigate whether for patients with incurable cancer comprehensive home care programmes are more effective than standard care in maintaining the patients' quality of life and reducing their "readmission time" (percentage of days spent in hospital from start of care till death). DESIGN: Systematic review. METHODS: A computer aided search was conducted using the databases of Medline, Embase, CancerLit, and PsychLit. The search for studies and the assessment of the methodological quality of the relevant studies were performed by two investigators, blinded from each other. Prospective, controlled studies investigating the effects of a home care intervention programme on patients' quality of life or on readmission time were included in the analyses. RESULTS: Only 9 prospective controlled studies were found; eight were performed in the United States and 1 in the United Kingdom. Their methodological quality was judged to be moderate (median rating 62 on a 100 point scale). None of the studies showed a negative influence of home care interventions on quality of life. A significantly positive influence on the outcome measures was seen in 2 out of the 5 studies measuring patients' satisfaction with care, in 3/7 studies measuring physical dimensions of quality of life, in 1/6 studies measuring psychosocial dimensions, and in 2/5 studies measuring readmission time. The incorporation of team members' visits to patients at home or regular multidisciplinary team meetings into the intervention programme seemed to be related to positive results. CONCLUSIONS: The effectiveness of comprehensive home care programmes remains unclear. Given the enormity of the problems faced by society in caring for patients with terminal cancer, further research is urgently needed.

Controlled Clinical Trials as Topic↗
PubMed1998

Care process and satisfaction analysis of a transmural home care program.

This study investigated both professional caregiver workload as well as the patients' and caregivers' satisfaction with a transmural home care program. Seventy-nine patients were included in the intervention program. The specialist nurse coordinator, general practitioner, community nurse providing 'intensive' community care, community nurses providing 'standard' community care, and the home helper spent in total an average of 7.5, 4.4, 55.6, 55.0, and 112.3 h, respectively, on each patient during the care process (mean survival of the 79 patients was 101.2 days). The 24 h telephone service and transmural home team were contacted in total 100 and 8 times, respectively. Patient and caregiver satisfaction with the care provided scored (very) high. Considering this acceptable workload and given that the program did not interfere with existing standard health care structures, it can be concluded that such care may easily be introduced by other hospitals and related primary care teams.

Attitude of Health Personnel↗
PubMed1998

Transmural care. A new approach in the care for terminal cancer patients: its effects on re-hospitalization and quality of life.

Despite their wishes, terminal cancer patients are frequently readmitted to hospitals. This appears in part to be due to poor communication amongst professional caregivers and/or the overburdening of their (informal) caregivers. This quasi-experimental study investigated the effects of a transmural home care programme on re-hospitalization, quality of life and place of death for terminal cancer patients. The programme intended to optimize communication, cooperation and coordination between intra- and extra-mural health care organizations (transmural care). Initial patient characteristics of the intervention group (n = 79) matched those of the control group (n = 37) well. When compared to the control group, which received the standard community care, patients in the intervention group underwent significantly less re-hospitalization during the terminal phase of their illness (5.8 versus 11.5 days; P < 0.01) while the intervention contributed significantly positive to the patients' "physical" quality of life 1 month after the start of the intervention. A higher, but not significant (P = 0.06) percentage of patients in the intervention group also died at home (81 versus 65%). The introduction of measures to enhance coordination and cooperation of intra- and extramural care, seems to be an improvement compared to standard community care.

Aged↗
PubMed1998

Cost analysis of transmural home care for terminal cancer patients.

The economic implications of home care service programmes for oncology patients remain unclear. This quasi-experimental study investigated the costs of a transmural home care programme for terminal cancer patients and compared them to those of the standard care available. The programme intended to optimize communication, cooperation and coordination between the intra- and extra- mural health care organizations (transmural care). Complete sets of data could be retrieved for 57 of the 79 patients in the intervention group, and for 29 of the 37 patients in the control group. Comparison of the intervention and control group revealed significantly lower pharmaceutical and rehospitalization costs in the intervention group, whilst community nursing and home help costs were significantly higher. However, no significant difference could be found for total health care costs between the groups. In view of this, and that the programme has proved to have significantly positive effects on both the patient's and direct caregiver's quality of life, the installation of such programmes in every hospital with a multidisciplinary oncology unit is recommended.

Aged↗
PubMed1997

Effects of four different methods of sampling arterial blood and storage time on gas tensions and shunt calculation in the 100% oxygen test.

At the present time, plastic syringes are most commonly used for collecting arterial blood. The oxygen tension of the arterial blood (Pa,O2) in these syringes may fall. We studied the effect of the type of syringe, metabolism, and storage time on the arterial oxygen pressures measured and on the pulmonary shunt calculated. In 10 patients, 2-3 h after aortacoronary bypass surgery, a 100% oxygen test was performed. Four arterial blood gas samples were withdrawn from each patient in random order, two in glass syringes and two in plastic syringes. One glass and one plastic syringe were stored at room temperature (RT), and the others were stored in ice-water (IW). Each sample was analysed as soon as possible, and repeated 15, 30, 60 and 120 min after sampling. The Pa,O2 measurement in blood in the glass syringe in IW measured as soon as possible after sampling was considered the "gold standard". Pulmonary shunt calculations were performed using the results of the various blood gas analyses. Compared with the "gold standard", all of the other methods showed significant deterioration in the Pa,O2 measurement. The effect due to diffusion was 0.05 kPa x min(-1), and that due to metabolism 0.11 kPa x min(-1). The Pa,O2 in the glass syringes stored in IW remained stable with time. The pulmonary shunt was significantly overestimated when the "gold standard" blood gas results were not used (range 0.8-9.9%). Glass (not plastic) syringes should be used in the 100% oxygen test. The syringe should be cooled immediately, even when the sample is analysed as soon as possible.

Arteriovenous Shunt, Surgical↗
PubMed1996

[Opportunistic lung infections in patients with chronic obstructive lung disease; a side effect of inhalation corticosteroids?].

In four patients, men of 64, 66 and 69 years old and a woman of 65 years, who suffered from chronic obstructive pulmonary disease (COPD) and used inhalation corticosteroids in a relatively high dose (800-1600 micrograms of budesonide per day), a pulmonary infection was diagnosed caused by Mycobacterium malmoense (the first two patients) and Aspergillus (the other two) respectively. Inhalation corticosteroids are of great importance in the treatment of asthmatic patients. Their place in the treatment of patients with COPD is much less clear. The patients did not have an immunological deficiency or anatomical pulmonary or bronchial deformation which could have explained the occurrence of these infections. The high dosages of inhalation corticosteroids may have been involved in the cause of these infections by suppressing the T-cell response locally. In view of this, longterm inhalation corticosteroid treatment should be prescribed in COPD patients only if the efficacy of the medication has been proved in the individual patient involved.

Administration, Inhalation↗
PubMed1994

Bochdalek hernia: a rare cause of pleural empyema.

This case report describes pleural empyema, caused by an intrathoracic ruptured stomach, in an adult patient with Bochdalek hernia. The possible complications and difficulties in diagnosing Bochdalek hernia in the adult are discussed.

Adult↗
PubMed1993

Interatrial right-to-left shunting developing after pulmonary resection in the absence of elevated right-sided heart pressures. Review of the literature.

Considering the literature, a symptomatic right-to-left (R-L) shunt through a persistent foramen ovale (PFO), developing after a pulmonary resection, can occur without elevated right-sided heart pressures, but its frequency seems to be very low. However, considering the high frequency of a PFO in the normal population (20 percent) and the high frequency of pulmonary resections carried out today, it might be possible that this kind of complication is occurring more frequently, possibly in a more "benign" form, in which it is more difficult to recognize, especially if one is unaware of the possibility of this kind of complication. This R-L shunt seems to occur more frequently after a right-sided pneumonectomy. Important clinical clues suggestive for this complication are as follows: first, a relatively symptomless interval of a few months between the operation and the onset of symptoms; second, the posture dependency of the dyspnea, ie, the dyspnea becoming worse in the upright position (platypnea); and third, the volume dependency of the R-L shunt, ie, the shunt becoming worse in a dehydrated state.

Aged↗
PubMed1991

Dyspnoea after pneumonectomy.

We report the case of a 61 yr old male, who developed a severe right-to-left shunt through a patent foramen ovale, in the absence of elevated right-sided heart pressures, two months after a left-sided pneumonectomy. This is considered to be a rare complication after pneumonectomy. However, taking into account the approximately 20% incidence of patent foramen ovale in the general population, we suggest that right-to-left shunting through an unsuspected foramen ovale or atrial septum defect should always be considered as a possible cause of otherwise unexplained hypoxaemia.

Dyspnea↗
PubMed1990

Bullous degeneration of the left lower lobe in a heroin addict.

A 34 yr old heroin addict was referred because of chest pain caused by air-trapping in a bulla in the left lower lobe. There was a marked difference between the functional residual capacity measured by body-plethysmography and helium dilution. A slow wash-in and wash-out were demonstrated by ventilation scintigraphy with Xenon133. Bullous degeneration is a known complication of intravenous drug abuse. Usually these bullae are found in the upper lobes. Possible causative mechanisms are discussed.

Adult↗
PubMedDate not supplied

Transmural care of terminal cancer patients: effects on the quality of life of direct caregivers.

BACKGROUND: The burden of caring for terminal cancer patients has a negative effect on the informal caregivers' quality of life. OBJECTIVES: To investigate the effects of a transmural home care intervention program for terminal cancer patients on the direct caregivers' (the patient's principal informal caregiver) quality of life, compared with standard care programs. The intervention program intended to optimize the cooperation and coordination between the intramural and extramural health care organizations (transmural care). METHODS: Direct caregivers of terminal cancer patients (estimated prognosis of less than 6 months) could be included in this quasi-experimental study. The direct caregivers' quality of life was measured in a multidimensional way 1 week before (T1), 1 week after (T2), and 4 weeks after (T3) the patient's discharge from the hospital (discharge being the starting point of the intervention), then again at 3 months after the patient's death (T4). Factor analyses on the four outcome measures yielded one factor. This was considered the primary outcome measure and was named the Overall Quality of Life Index (OQOLI). RESULTS: Multiple regression analyses showed that the intervention contributed significantly positively to the direct caregivers' OQOLI at T2 (beta=.30; p < .05) and T4 (beta=.28; p < or = .05), compared with standard care. CONCLUSION: Transmural care forms a significantly positive contribution to the OQOLI of direct caregivers of terminal cancer patients 1 week after the patient's discharge from the hospital and 3 months after the patient's death. Good terminal care also appears to be important for direct caregivers as well, with respect to perceived quality of life.

Adult↗
PubMedDate not supplied

Exhaled biomarkers in COPD: their potential role in diagnosis, treatment and prognosis.

Several diagnostic tools have been developed for diagnosing, monitoring and evaluating Chronic Obstructive Pulmonary Disease (COPD). There is an increasing interest in the use of non or less invasive biological markers (biomarkers) which reflect the character and intensity of the pathological processes in the lungs of COPD patients. The main goal of this review was to discuss the origin and current role of exhaled biomarkers in the diagnosis, evaluation of treatment and prognosis of COPD. Data of cross-sectional, cohort and intervention studies on exhaled biomarkers were studied. These studies were identified by a Medline search on papers in the English language published from 1990 to November 2001. The following markers were discussed: exhaled nitric oxide (NO), exhaled carbon monoxide (CO), exhaled alkanes, exhaled hydrogen peroxide (H2O2), exhaled isoprostanes, exhaled NO metabolites and exhaled thiobarbituric acid-reactive substances (TBARs). Data on these markers were summarized. The origin of each marker, the technique of analysis, the values in healthy controls and COPD patients, the effect of treatment and the correlation with other parameters were presented. Most studies, however, were cross-sectional studies with small populations. It was also difficult to compare studies because of differences in technique and study population. This review shows that exhaled biomarkers need to be studied further before using them in clinical practice. There is a need for standardization of the measurements, for comparison of COPD patients with healthy persons matched for age and smoking-status, for data on reproducibility and variability of all markers, for correlation of exhaled markers with other parameters and for intervention studies.

Biomarkers↗