Biomedical subjects

G H de Bock

Publications and source records attributed to G H de Bock.

At least 19 recordsLinked to original sources

PubMed1998

Identifying asthma and chronic obstructive pulmonary disease in patients with persistent cough presenting to general practitioners: descriptive study.

OBJECTIVE: To determine the prevalence of asthma and chronic obstructive pulmonary disease in patients not known to have these disorders, who present in general practice with persistent cough, and to ascertain criteria to help general practitioners in diagnosis. DESIGN: Descriptive study. SETTING: Primary healthcare centre in the Netherlands. SUBJECTS: 192 patients aged 18-75 years, not known to have asthma or chronic obstructive pulmonary disease, attending their general practitioner with cough persisting for at least 2 weeks. : A diagnosis of asthma or chronic obstructive pulmonary disease was based on the recurrence of airway symptoms in the past year accompanied by spirometric measurements (including bronchodilator testing) and methacholine provocation tests. A scoring formula to estimate the probability of asthma or chronic obstructive pulmonary disease, based on history and physical examination, was generated by means of logistic regression. RESULTS: 74 patients (39%) were classified as having asthma, 14 (7%) as having chronic obstructive pulmonary disease. The best formula for predicting asthma or chronic obstructive pulmonary disease used scores for three symptoms: (reported) wheeze, (reported) dyspnoea, and allergen induced symptoms, together with prolonged expiration, pack years of smoking, and female sex. Variables were scored 1 when present and 0 when absent, except for allergen induced symptoms (1.5) and number of pack years of smoking (n/25). With a cut off value of 3 on the scoring formula, 76% of the patients could be classified correctly. CONCLUSIONS: About half of patients with persistent cough who present to a general practitioner have asthma or chronic obstructive pulmonary disease. With a simple formula based on three symptoms and prolonged expiration, pack years of smoking, and female sex, most patients may be identified correctly in general practice.

Adolescent↗

PubMed1997

Antimicrobial treatment in acute maxillary sinusitis: a meta-analysis.

OBJECTIVE: The aims of this study were to assess which antibiotic is most effective in the treatment of acute maxillary sinusitis in otherwise healthy adults and adolescents, and which has the fewest side effects. DESIGN: To assess the short-term effects of antimicrobial treatments, a meta-analysis was performed using Mantel-Haenszel procedures on 16 comparative, randomized studies with a total number of 3358 patients. No placebo-controlled studies were available. Antimicrobial treatments were categorized according to type, spectrum, beta-lactamase inhibition, and bactericidal effect. Outcomes were clinical cure, clinical success, and adverse events. RESULTS: When studies were analyzed separately, we found significant differences between cefpodoxim and cefaclor in relation to clinical cure, and between loracarbef and doxycycline in relation to clinical success. When data was pooled, sulphonamides were significantly more effective than penicillins in relation to clinical cure, and macrolids were more effective than penicillins in relation to clinical success, whereas cephalosporins caused significantly less adverse events than penicillins. When studies were stratified (standard classic meta-analysis), antibiotics with beta-lactamase inhibition offered significantly more clinical cures than antibiotics without beta-lactamase inhibition. However, this significant effect was only due to one study from Southern Europe, published before 1991. CONCLUSION: Differences in outcome between antimicrobial treatments of acute sinusitis in otherwise healthy adults and adolescents appear to be small. Therefore, the cheapest antimicrobial treatment can be selected.

Acute Disease↗

PubMed1997

A postmarketing study of flunarizine in migraine and vertigo.

This prospective, open multi-centre study on flunarizine focused on the risk/benefit ratio of the use of flunarizine in the prophylaxis of migraine and in the treatment of vertigo, due to disorder of the vestibular system. The assessment of risks focused on the incidence of new events of depression and/or extrapyramidal syndrome during flunarizine treatment. For migraine, flunarizine was compared to propranolol in 686 patients; for vertigo, flunarizine was compared to betahistine in 198 patients. The incidence of depression during follow-up in this study was significantly higher in the flunarizine group than in the propranolol group in the condition of migraine. There were no observations of an extrapyramidal syndrome. There was a suggestion that flunarizine has more benefits than propranolol in the condition of migraine, and that betahistine has more benefit than flunarizine in the condition of vertigo. Differences in dosages could possible explain these differences.

Adult↗

PubMed1997

Women worried about their familial breast cancer risk--a study on genetic advice in general practice.

AIMS: To ascertain whether women who consulted their GP because they perceived themselves as at increased risk of familial breast cancer were indeed at increased risk, and to evaluate potential strategies for assessing genetic risk of breast cancer in general practice. METHODS: Sixty-seven out of 81 women who had consulted their GP for advice about their possible increased risk of developing breast cancer due to breast cancer in the family were interviewed. Familial breast cancer risk was assessed by a clinical geneticist. This assessment was compared with two recent guidelines for referral for genetic counselling. RESULTS: More than half (52%; n = 35) the women had a relative risk of two and over for developing breast cancer, while another half of these 35 (25%; n = 17) had a relative risk of three and over. All the women (n = 17) with a relative risk of three and over were identified by means of the two current guidelines for referral for genetic counselling, while more than half of the women (61%; n = 11) with a relative risk between two and three were identified. CONCLUSIONS: More than half the women concerned about their familial risk of breast cancer are indeed at increased risk of breast cancer. Current guidelines correctly identify women at high risk. However, doubts about the health gain and feasibility of referral warrant caution, and need further investigation.

Adult↗

PubMed1997

The pattern of health care utilization of elderly people with arthritic pain in the hip or knee.

OBJECTIVE: The aim of the study was to determine the pattern of health care utilization of people aged 55-74 years with arthritic pain in the knee or hip. DESIGN: People with current pain were identified in a population-based study. A filter model was used to describe the pattern of health care utilization of people who presented as patients at different levels (GPs or specialist) of the health care system in the Netherlands. SETTING: The study was carried out in the district of Ommoord in Rotterdam in an age- and gender-representative sample of 831 (response 83%; n = 691) people. STUDY PARTICIPANTS: A group of 186 people with current pain was identified. They completed a questionnaire and were interviewed. MAIN OUTCOME MEASURES: Background variables, illness-related variables (including radiological osteoarthritis), and self-reported diagnoses were described and compared for attenders and non-attenders of GPs and specialists. A reference group of patients of GPs was used to determine the validity and generalizability of the findings. RESULTS: Eighty-two per cent consulted a GP (passed filter 1). In 69% of the GP attenders, 'arthritis' was identified (passed filter 2), and 65% of them attended a specialist (passed filter 3). People who did not pass the various filters were different from those who did with respect to the body mass index (lower; OR 1.24), the chronicity of pain (less chronic pain; OR 4.9) and attendance of a physiotherapist (lower; OR 5.6). The chronicity of pain seems of more importance in determining the health care utilization pattern than the severity of pain, the level of disability or the presence of radiological osteoarthritis. We suggest that health promotion interventions could increase the self-management ability of patients and could lower costs.

Aged↗

PubMed1997

Prostate symptoms in general practice: seriousness and inconvenience.

OBJECTIVE: To estimate the seriousness and inconvenience of prostatism in a general practice population and to assess the consultation with the general practitioner (GP) in relation to seriousness of prostatism. DESIGN: A questionnaire was sent to a random sample of 979 men aged 50 years and over from two general practices in a village, and two in a city in the western part of The Netherlands. MAIN OUTCOME MEASURE: Seriousness and inconvenience of prostatism according to the Symptom Index for Benign Prostatic Hyperplasia. Consultation with the GP for urinary symptoms. RESULTS: The prevalence of prostatism with moderate to severe symptoms was 20%. The majority (60%) of the men with prostatism did not consult their GP with these symptoms, and one fifth (19%) felt "mostly dissatisfied" to "terrible" due to their symptoms. Of this last group, a few (1.4% of the total population) nevertheless did not consult their GP. CONCLUSIONS: Prostatism is a symptom complex caused not only by benign prostate hyperplasia. Prostatism is under-reported in general practice. Men with micturition problems should be encouraged to consult their practitioner.

Aged↗

PubMed1996

Health-related quality of life assessments in osteoarthritis during NSAID treatment.

There is some evidence that nabumetone (1000 mg once daily) in comparison with piroxicam (20 mg once daily) in patients with OA in general practice is associated with a lower incidence and less severe occurrence of stomach pain but with more withdrawals due to lack of efficacy. The aim of this analysis was to investigate whether these differences are reflected in health-related quality of life assessments. Patients (n = 198) included in this study were selected in general practice according to a protocol. The patients were randomized and treated for a period of six weeks. Clinical assessments were performed by the general practitioner (CP) during treatment. The Sickness Impact Profile (SIP), the Activities of Daily Living (ADL), and a pain questionnaire were filled out by the patients before and after treatment. As measured with the SIP, the ADL and the pain questionnaire, there were no significant differences between nabumetone and piroxicam. The correlations between (changes in) patient assessments and (changes in) clinical assessments were low. The differences between the two drugs regarding withdrawals and adverse events were not reflected by patient health-related quality of life assessments. There was a low correlation between patient health-related quality of life assessment and clinical assessments. To get a complete picture of the efficacy and safety of a drug, patient health-related quality of life assessments should be a part of a clinical trial.

Adult↗

PubMed1996

Prevalence of depression and clues to focus diagnosis. A study among Dutch general practice patients 65+ years of age.

AIMS: To assess the prevalence of depression in elderly patients presenting in general practice, and to assess which patient characteristics and presenting symptoms are useful clues for predicting depression. DESIGN: Cross-sectional survey based on data collected at the presenting consultation and at a subsequent domiciliary interview. SUBJECTS AND SETTING: 580 of 706 consecutive patients aged 65+ years consulting 13 general practitioners in the Netherlands. METHOD: GPs entered data on presenting symptoms and their assessment of psychological state during the consultation. Formal psychiatric assessment was subsequently done at home using the Diagnostic Interview Schedule (plus additional questions to assess minor depression according to ICHPPC-2-Defined). Major depression and dysthymia were assessed with the Diagnostic Interview Schedule. RESULTS: The estimated prevalence of depression (both major and minor plus dysthymia) was 7.9%, and was very similar whether based on GP assessment or formal validated interview schedule, but the GPs did not identify the same patients as the formal psychiatric assessment. GPs identified only 26% (95% CI 4-71%) of patients with major depression. Clinical clues which could help the GP to suspect underlying depression were female gender, the presentation of vague symptoms, and gastrointestinal symptoms. CONCLUSIONS: Although presentation of symptoms does provide some clues about the likelihood of underlying depression, the sensitivity of GP diagnosis remains low and needs to be improved.

Aged↗

PubMed1996

[Peripheral arthritis in family practice].

Osteoarthritis is a common disease of the cartilage in a joint for which the general practitioner (GP) is frequently consulted. In this contribution the current policy of GPs is described with respect to patients with peripheral osteoarthritis. For this purpose, the medical records of 196 patients from 14 Dutch general practitioners were studied with regard to the GPs management, and the GPs were interviewed about their management. Also, the burden of osteoarthritis was assessed in terms of quality of life for 198 patients. Moreover, the effects of two nonsteroidal treatments (nabumetone versus piroxicam) were studied in 198 patients. GPs management is heterogeneous. The results of the interviews supported this finding. The quality of life of patients with osteoarthritis was significantly reduced in several areas of daily living. After treatment with nonsteroidals the patients' status improved, according to both the GPs and the patients. The GPs and the patients' perspective on change correlated weakly. In future research, it would be interesting to explore these two perspectives.

Adult↗

PubMed1996

The whispered voice: the best test for screening for hearing impairment in general practice?

Hearing loss is an important health problem in the elderly which sometimes leads to social isolation. In a study with 62 patients, the diagnostic value of four simple tests for screening for hearing loss in general practice was examined. When paying attention to the loudness of the whispering, the whispered voice test can be a valuable test for assessment of hearing loss in general practice.

Aged↗

PubMed1995

Health-related quality of life in patients with osteoarthritis in a family practice setting.

OBJECTIVE: To study the impact of osteoarthritis (OA) on all areas of a patient's health-related quality of life. METHODS: The Sickness Impact Profile (SIP) was administered to a group of patients with OA selected from a family medicine setting. The results were compared to a reference population, stratified by age, and adjusted for sex. RESULTS: OA was associated with significant impairment, and had an important impact on, health-related quality of life in the areas of ambulation, body care and movement, emotional behavior, sleep and rest, home management, and work, especially in patients ages 41-60. The older patients differed less from the controls than did the younger ones. Items that contributed to the differences between OA patients and controls were mainly related to physical limitations. CONCLUSION: Most dysfunctions related to OA are physical.

Adult↗

PubMed1995

European postmarketing surveillance of ramipril in hypertension. 1. Feasibility and study cohort.

A prospective observational cohort study of the angiotensin inhibitor, ramipril, was undertaken in four countries within the European Community-Netherlands, United Kingdom, Germany and Belgium. A total of 10,377 consecutive patients with essential hypertension were recruited to the study with the aim of follow-up for one year. Overall 37% of doctors who agreed to participate in the study actually enrolled at least one patient. One third of the doctors who enrolled patients in the study entered two thirds of patients studied. Some 15% of participating males and 27% of females were aged over 70 years. Newly diagnosed hypertensives comprised 22% of the study cohort, the proportion being highest in UK and Netherlands, whereas 53% were established hypertensives of two or more years' duration, the proportion being highest in Germany and Belgium. There were substantial differences among the participating countries in the concurrent treatment these patients were receiving for hypertension, with two or more co-therapies being most frequent in Germany and Belgium. There were also substantial differences in co-therapies for concurrent diseases among the participating countries, reflecting both standard therapeutic practices in local areas and differences in marketing of drugs in the different countries. This report describes the initial findings of this multinational study and emphasises the need to consider several major potentially confounding variables in the analysis of the outcome events both in this study and in other collaborative observational international monitoring schemes for adverse drug reactions.

Aged↗

PubMed1995

Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale.

BACKGROUND: Many scales have been developed to assess depression, but they are often too lengthy to be of practical use in general practice consultations. AIM: A study was undertaken to investigate the feasibility, reliability and diagnostic value of the geriatric depression scale and its shorter versions for screening in general practice. METHOD: A total of 586 consecutive consulting patients aged 65 years and over were studied in nine general practices in the west of the Netherlands (13 doctors). The 30-item version of the geriatric depression value was compared with the diagnostic interview schedule as a reference test. RESULTS: The reference test indicated a major depression in six patients while 27 patients had a dysthymic disorder (that is, a chronic mild depression). Five per cent of patients required help for 50% of the questions on the geriatric depression scale. The diagnostic value of the 30-item, 15-item, 10-item and four-item versions did not differ significantly, but the one-item version performed no better than chance. Two items discriminated best between patients who were and who were not depressed (P < 0.05), only one of which was included in a previously proposed four-item version of the scale. The reliability of the proposed four-item version was 0.64, the reliability of the other versions ranging from 0.70 to 0.87. CONCLUSION: The results for the different versions of the geriatric depression scale suggest the use of a 10-item or a four-item version. For practical purposes, the smallest subset would be the most desirable: the four-item version. These scales may be better suited for exclusion rather than inclusion purposes. The feasibility of screening for depression in elderly people in a general practice setting is discussed in the light of the results of the study.

Aged↗

PubMed1994

Osteoarthritis pain assessment in family practice.

PURPOSE: The objective is to study the assessment of pain severity, following the conventional family physician routines, in patients with peripheral osteoarthritis. METHODS: The patient's perception of pain and the physician's assessment of the pain were measured by means of questionnaires and were compared in a study population of 198 patients with osteoarthritis. RESULTS: A rather low association was found between a patient's perception of pain and the physician's assessment of pain. CONCLUSIONS: It is an accepted fact that too much treatment can have undesirable effects, and that inadequate management of symptoms seems to be associated with a reduced quality of life in osteoarthritic patients. In the absence of a high correlation between patient's perception and physician's assessment of pain severity, it is concluded that a patients' pain questionnaire could be a very useful instrument for improving the care given to patients with osteoarthritis in family practice.

Adult↗

PubMed1994

Sensitivity and specificity of diagnostic tests in acute maxillary sinusitis determined by maximum likelihood in the absence of an external standard.

This study shows how to obtain maximum likelihood estimates of test sensitivities and specificities in case of lack of an external standard, using the Expectation Maximisation (EM) algorithm. This method is used to compare four diagnostic tests in patients suspected of acute maxillary sinusitis. Data were analyzed from published studies. Antral aspiration is the test with the highest diagnostic value. The diagnostic value of a positive clinical examination (according to explicit criteria) and of a positive radiograph or ultrasound are comparable. A negative radiograph is of more diagnostic value than a negative clinical examination or ultrasound. The width of the confidence intervals may be too small, due to model deviations which may give incorrect standard errors. However, the estimated likelihood ratios adequately reflect the relative value of the diagnostic tests considered, even when the assumption of independence is dropped.

Acute Disease↗

PubMed1994

Acute maxillary sinusitis in general practice: a decision problem.

OBJECTIVE: This paper describes a qualitative analysis of a decision problem of acute maxillary sinusitis in general practice. The criteria and expected outcomes on which general practitioners (GPs) base their choice of a management strategy are presented. DESIGN: Structured open-ended interviews, all done by the first author, were transcribed, and summarized for each management strategy. These summaries were sent back to the experts for verification. PARTICIPANTS: Eight expert GPs from The Netherlands participated; all had been practising for at least three years, and had conducted postgraduate research into upper respiratory tract infections. RESULTS: There was a high degree of consensus among the eight GPs. While most practitioners generally considered the prevention of complications of therapy more important than the prevention of complications of disease, patients at risk (e.g., the elderly, children, patients with other chronic diseases, and patients in weakened condition) of complications of acute sinusitis (e.g., chronic sinusitis) were considered an exception to this rule, possibly because the complications of sinusitis are more serious than those of its therapy. Major differences between the GPs concerned the timing of decisions (e.g. prescribing antibiotics after 5 or 21 days of complaints while local therapy was used). CONCLUSION: Although this study gives no answer as to which management strategy is optimal, the results served as a basis in the development of the Dutch "Sinusitis in general practice standard". In order further to develop the optimal strategy, in future research, the probabilities and weights attached to the criteria and expected outcomes have to be quantified.

Acute Disease↗

PubMed1994

Management of depression in elderly general practice patients.

OBJECTIVE: To describe general practitioners' (GP) management (i.e., recognition and treatment) of depression in elderly patients. DESIGN: Two separate studies were performed: (a) to study recognition of depression, a postal survey was sent to GPs; (b) to evaluate the consistency of treatment, patients considered depressed by GPs were described. SETTING: general practices in the West of The Netherlands. SUBJECTS: 65 GPs, and 44 patients of 7 GPs. MAIN OUTCOME MEASURES: (a) degree of recognition of depression as described in major depression case-vignettes (b) consistency of treatment. RESULTS: (a) On average 65% of the GPs recognized every depressive symptom in case-vignette one, while 52% of GPs recognized each symptom in case two. Most (39) doctors used a time criterion of less than 5 weeks for depressive disorder. (b) Depressed patients with at least three depressive symptoms all received treatment. Chronically depressed patients appeared to be treated somewhat inadequately. CONCLUSION: The results suggest some inadequate knowledge of criteria for major depression and some inconsistency in treatment. The management of depression in elderly GP patients appears to need improvement.

Aged↗

PubMed1993

[Relationship between unwanted urine loss to other limitations in function].

A limited analysis of the data of the continuous health enquiry of the Central Statistics Office regarding forms of physical impairment of the non-institutionalized Dutch population and of some data on physical ability of nursing home patients, carried out in 1991 by the Health Care Information Centre Foundation, confirmed the supposition that the risk of unwanted urine loss is substantially higher in patients with disability with respect to locomotion, changing posture, purposeful action, communication and condition. This proved to be the case at all ages, in both sexes, and in those living alone and together with others. Further investigation is necessary to determine the connection of these various forms of impairment with each other and with involuntary urine loss, with a view to promoting efficient diagnostic and therapeutic coping with involuntary urine loss; special attention should be paid to the question to what extent the disorders and limitations contribute to the actual handicap.

Activities of Daily Living↗