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Biomedical subjects

J E Jacobs

Publications and source records attributed to J E Jacobs.

At least 19 recordsLinked to original sources
PubMed2004

Impact of spirometry on GPs' diagnostic differentiation and decision-making.

BACKGROUND: Spirometry is increasingly implemented in general practice, while the ability of general practitioners (GPs) to interpret flow volume curves (F-V curves) has been questioned. Furthermore, the role of spirometry in the GPs decision-making process has barely been studied. AIM: To compare the achievements of trained GPs in spirometric diagnosis with an expert consensus panel (1) and to assess the influence of spirometry on the GPs decision-making (2). METHOD: Twelve cases including a wide range of F-V curves were interpreted by 39 GPs as well as the expert panel. Diagnostic test characteristics were calculated using multi-level analysis and summarised by diagnostic odds ratios (DOR). Differences in decision-making indicators were expressed as odds ratios and 95% confidence intervals. RESULTS: Normal F-V curves (DOR 65.0) and obstructive F-V curves (DOR 48.9) were reasonably well diagnosed, while rare and mixed pathological patterns achieved considerably lower scores (DOR 3.8). Intermediate scores were obtained in the recognition of incorrect test manoeuvres (DOR 24.4). Spirometry influenced the GPs decision-making in reducing the number of alternative diagnoses (OR 0.266 [0.200, 0.353]), but also increased referral rates (7.26 [4.71, 11.2]) and the use of diagnostic prednisolone courses (4.55 [3.12, 6.64]) substantially. CONCLUSION: Trained GPs were able to differentiate between normal and obstructive disease patterns, while F-V curves suggestive of rare and mixed pathology were often missed. Spirometry seems to influence the decision-making process of the GP; whether this represents an initial or a more sustained effect remains to be evaluated in studies of daily primary care practice.

Adult↗
PubMed2004

The efficacy of smoking cessation strategies in people with chronic obstructive pulmonary disease: results from a systematic review.

Smoking cessation is the most effective way to reduce the risk of developing chronic obstructive pulmonary disease (COPD). It prevents or delays the development of airflow limitation and also reduces its progression. The objective of this study was to systematically review the effects of interventions for smoking cessation in people with COPD. Comprehensive searches of electronic and internet databases were carried out from 1966 to March 2002, using the Cochrane Airways Group search strategy. The reference lists of all selected randomized trials and relevant reviews were inspected for additional published reports and citations of unpublished research. We evaluated the efficacy of behavioural interventions (e.g. counselling), pharmacotherapy (nicotine replacement therapy and non-nicotine therapy such as bupropion), and combinations of both. The main clinical outcome measure was prolonged abstinence after at least 6 months, confirmed by a biochemical test. Five trials comprising 6491 patients with COPD were included. Results of the Lung Health Study show that, by using an intensive behavioural (relapse prevention) programme combined with nicotine replacement therapy, prolonged abstinence rates are not only significantly higher compared with no intervention, but the difference in efficacy was sustained for over 5 years. A 12-week treatment course with bupropion sustained release combined with individual counselling, however, did not result in significantly higher prolonged abstinence rates after 12 months. Present evidence suggests that the most effective intervention for prolonged smoking cessation in patients with COPD is the combination of nicotine replacement therapy, coupled with an intensive, prolonged relapse prevention programme.

Behavior Therapy↗
PubMed2004

Assessing the quality of life of adults with chronic respiratory diseases in routine primary care: construction and first validation of the 10-Item Respiratory Illness Questionnaire-monitoring 10 (RIQ-MON10).

BACKGROUND: As doctors' judgements about the burden of a disease often differ from patients' own assessments a manageable method to incorporate the latter into routine care might support patient-centered decision-making. For this purpose we shortened the 55-Item Quality of Life for Respiratory Illness Questionnaire (QoL-RIQ). METHODS: Secondary analyses of the data of 3 controlled studies (n = 328, 502 and 555). PROCEDURES: inter-item correlations, scale distributions, Cronbach's alpha and factor analysis. Dyspnoea, forced expiratory volume in 1 s (FEV1), COOP/WONCA charts, the Medical Research Council-ECCS symptoms questionnaire and the MOS-SF 36 served as criteria to test validity and responsiveness. RESULTS: Item-reduction resulted in a 10-item short form (alpha's 0.87-0.90), consisting of 2 5-item factors: (1) physical and emotional complaints and (2) physical and social limitations. The correlations of the short form with dyspnoea (r from 0.57 to 0.60), the generic health status instruments (r from 0.39 to 0.59) and lung function (r from 0.10 to 0.15) fulfilled the criteria. FURTHER RESULTS: a clinical relevant score difference (> 0.5) between upper and lower quartiles of the convergent instruments, an intraclass correlation between repeated scores in a stable group of 0.82 and a standardised response mean of 0.86 in an improved group of patients. CONCLUSIONS: The short form (RIQ-MON10) maintained the psychometric properties of the original instrument and is promising for assessing quality of life (QoL) during routine primary care visits.

Asthma↗
PubMed2003

Smoking cessation for chronic obstructive pulmonary disease.

BACKGROUND: Smoking cessation is the most important treatment for smokers with chronic obstructive pulmonary disease (COPD), but little is known about the effectiveness of different smoking cessation interventions for this particular group of patients. OBJECTIVES: To determine the effectiveness of smoking cessation interventions in people with COPD. SEARCH STRATEGY: Electronic searches were undertaken on MEDLINE (from 1966 to March 2002), EMBASE (from 1989 to March 2002) and Psyclit (from 1971 to March 2002), and CENTRAL (Issue 1, 2002). SELECTION CRITERIA: Randomised controlled trials in which smoking cessation was assessed in participants with confirmed COPD. DATA COLLECTION AND ANALYSIS: Two authors extracted the data and performed the methodological quality assessment independently for each study, with disagreements resolved by consensus. High-quality was defined, based on pre-set criteria according to the DelphiList. MAIN RESULTS: Five studies were included in this systematic review, two of which were of high-quality. The high-quality studies show the effectiveness of psychosocial interventions combined with pharmacological intervention compared to no treatment: psychosocial interventions combined with nicotine replacement therapy (NRT) and a bronchodilator versus no treatment at a 5 year follow-up (RD = 0.16, 95% CI 0.14 to 0.18), (RR = 4.0, 95% CI 3.25 to 4.93), psychosocial interventions combined with NRT and placebo versus no treatment at a 5 year follow-up (RD = 0.17, 95% CI 0.14 to 0.19), (RR = 4.19, 95% CI 3.41 to 5.15). Furthermore the results show the effectiveness of various combinations of psychosocial and pharmacological interventions at a 6 months follow-up (RD = 0.07, 95% CI 0.0 to 0.13), (RR = 1.74, 95% CI 1.01 to 3.0). Unfortunately, none of the included studies compared psychosocial interventions with no treatment. Therefore we found no evidence with regard to the effectiveness of these interventions. REVIEWER'S CONCLUSIONS: Based on this systematic review, the authors found evidence that a combination of psychosocial interventions and pharmacological interventions is superior to no treatment or to psychosocial interventions alone. Furthermore we conclude that there is no clear or convincing evidence for the effectiveness of any psychosocial intervention for patients with COPD due to lack of a sufficient number of high-quality studies.

Behavior Therapy↗
PubMed2003

Validity of spirometric testing in a general practice population of patients with chronic obstructive pulmonary disease (COPD).

OBJECTIVE: To investigate the validity of spirometric tests performed in general practice. METHOD: A repeated within subject comparison of spirometric tests with a "gold standard" (spirometric tests performed in a pulmonary function laboratory) was performed in 388 subjects with chronic obstructive pulmonary disease (COPD) from 61 general practices and four laboratories. General practitioners and practice assistants undertook a spirometry training programme. Within subject differences in forced expiratory volume in 1 second and forced vital capacity (DeltaFEV1 and DeltaFVC) between laboratory and general practice tests were measured (practice minus laboratory value). The proportion of tests with FEV1 reproducibility <5% or <200 ml served as a quality marker. RESULTS: Mean DeltaFEV1 was 0.069 l (95% CI 0.054 to 0.084) and DeltaFVC 0.081 l (95% CI 0.053 to 0.109) in the first year evaluation, indicating consistently higher values for general practice measurements. Second year results were similar. Laboratory and general practice FEV1 values differed by up to 0.5 l, FVC values by up to 1.0 l. The proportion of non-reproducible tests was 16% for laboratory tests and 18% for general practice tests (p=0.302) in the first year, and 18% for both in the second year evaluation (p=1.000). CONCLUSIONS: Relevant spirometric indices measured by trained general practice staff were marginally but statistically significantly higher than those measured in pulmonary function laboratories. Because of the limited agreement between laboratory and general practice values, use of these measurements interchangeably should probably be avoided. With sufficient training of practice staff the current practice of performing spirometric tests in the primary care setting seems justifiable.

Adult↗
PubMed2002

A Delphi technique as a method for selecting the content of an electronic patient record for asthma.

INTRODUCTION: An electronic patient record (EPR) with disease-specific data may support improvement of the quality of care for patients with chronic diseases. The structure and content of such a record can only be assessed by clinicians in co-operation with IT-specialists, because, the result has to be clinically relevant, easily accessible and adjusted to the information needs of different workers in primary care. METHODS: We applied a modified Delphi-procedure--a method characterized by anonymous written comments by an expert panel. The panel had to agree about the question whether or not an item should be included in the EPR. The questions for the written comments were prepared by a steering committee (general practitioners (GP) and health scientists, either expert in asthma and disease management or IT-specialist) based on the guidelines for diagnosing and treating asthma of the Dutch College of General Practitioners (DCGP). When agreement within the panel was < or = 70%, we sent a modified format to the expert panel for reassessment. RESULTS: Three written commentary rounds were necessary, in which 95 potential items were discussed with the expert panel. In the first round they selected 50 items relating to diagnosing asthma and 22 concerning the treatment of asthma. During the second round 17 items were still under discussion and six were rejected. In subsequent rounds, the expert-panel assessed the best registration format (operationalisation). The written rounds failed to create a full consensus. Therefore the study ended with a consensus meeting of the expert panel. Due to the presence and contribution of nearly all experts, consensus could be reached about the structure and contents of the EPR on asthma. DISCUSSION: The modified Delphi procedure, proved to be a feasible method for selecting the optimal content of an electronic registration protocol. Both, written and verbal commentary rounds were necessary. The existence of a set of guidelines was essential.

Asthma↗
PubMed2001

Management of patients with asthma and COPD: monitoring quality of life and the relationship to subsequent GP interventions.

OBJECTIVES: The aim of this study was to investigate the feasibility of systematic monitoring of patients' quality of life and its relationship to GPs' interventions concerning management of asthma and chronic obstructive pulmonary disease (COPD). METHODS: A cross-sectional study on patients' self-reported quality of life in relation to GPs' subsequent interventions during consultation was performed. Fourteen GPs at six general practices in The Netherlands monitored 175 patients aged 18 years and older with asthma and COPD. Directly before each planned follow-up consultation, patients completed a self-report questionnaire (27 items, five dimensions) about their quality of life; GPs reviewed the monitoring scores during consultation and recorded their diagnostic and therapeutic interventions. The relationship between patients' perceived quality of life and GPs' medication prescription, smoking cessation advice, patient education and counselling was analysed. RESULTS: During 15 months, 175 patients underwent 537 consultations. In 57% of the consultations, patients reported impairments in their quality of life. This information was significantly associated with subsequent GP interventions (chi-square = 0.05), especially with providing patient education and counselling. Multivariate logistic regression analyses showed that reported physical complaints were positively associated with changes in medication prescription [odds ratio (OR) 1.7; 95% confidence interval (CI) 1.0-2.8] and with education about the control regimen (OR 1.9; 95% CI 1.1-3.3). Reported emotional complaints were related to extra follow-up appointments (OR 4.3; 95% CI 1.5-12.8) and to counselling (OR 7.3; 95% CI 2.9-18.3). In general, more advanced age was related to less patient education. Patients' and GPs' opinions about the quality of life monitoring were positive. CONCLUSIONS: Information about quality of life of patients, gathered systematically and routinely directly before consultation, could be integrated into a complex medical decision-making process; scores were related to various therapeutic interventions.

Adult↗
PubMed2001

Acute appendicitis: comparison of helical CT diagnosis focused technique with oral contrast material versus nonfocused technique with oral and intravenous contrast material.

PURPOSE: To compare the diagnostic accuracy of focused helical computed tomography (CT) with orally administered contrast material with that of nonfocused helical CT with orally and intravenously administered contrast material. MATERIALS AND METHODS: After receiving oral contrast material, 228 patients with clinically suspected appendicitis underwent focused appendiceal CT (5-mm section thickness, 15-cm coverage in the right lower quadrant). Immediately thereafter, helical CT of the entire abdomen and pelvis was performed following intravenous administration of contrast material (abdomen, 7-mm section thickness; pelvis, 5-mm section thickness). Studies were separated and independently interpreted by three observers who were blinded to patient names. Diagnoses were established by means of surgical and/or clinical follow-up findings. RESULTS: Fifty-one (22.4%) of 228 patients had acute appendicitis. Readers diagnosed appendicitis with 83.3%, 73.8%, and 71.4% sensitivity and 93.0%, 92.3%, and 97.9% specificity with focused nonenhanced appendiceal CT. Readers diagnosed appendicitis with 92.9%, 92.9%, and 88.1% sensitivity and 93.7%, 95.1%, and 96.5% specificity with nonfocused enhanced CT. Summary areas under the receiver operating characteristic curve estimates for focused nonenhanced and nonfocused enhanced CT were 0.916 and 0.964, respectively; the differences were statistically significant (P <.05) for two of three readers. All readers demonstrated higher sensitivities for detecting the inflamed appendix with nonfocused enhanced CT. Appendicitis was missed with focused CT in two patients whose inflamed appendix was not included in the imaging of the right lower quadrant. All readers were significantly more confident in diagnosing alternative conditions with nonfocused enhanced CT. CONCLUSION: Diagnostic accuracy of helical CT for acute appendicitis improved significantly with use of intravenous contrast material.

Acute Disease↗
PubMed2001

Disseminated aspergillosis inciting intestinal ischaemia and obstruction.

Invasive aspergillosis is an opportunistic infection that characteristically affects the immunocompromised host, resulting in a high degree of morbidity and mortality. Although the portal of entry is usually pulmonary, there are rare reports of invasive aspergillosis localized to the gastrointestinal tract. In addition, haematological spread may develop, with life threatening disseminated infection involving the vital organs and the gastrointestinal tract. Although disseminated infection is well recognized, the CT findings of gastrointestinal disease have not been reported to our knowledge. We describe the CT findings in a patient with invasive aspergillosis involving the gastrointestinal tract, which resulted in intestinal ischaemia complicated by small bowel obstruction.

Aged↗
PubMed2000

Isolated infarction of the cecum: CT findings in two patients.

Colonic ischemia isolated to the cecum is a rare entity. The authors evaluated two patients who underwent computed tomography (CT) because appendicitis was suspected at clinical examination. CT findings were suggestive of isolated cecal ischemia or infarction. Surgical-histopathologic findings helped confirm the presumptive CT diagnoses. Isolated cecal infarction should be included in the differential diagnosis of acute right lower quadrant pain.

Abdominal Pain↗
PubMed1999

[Role of spirometry in primary practice].

Spirometry is increasingly used in general practice and improves the possibilities regarding mainly the early detection and treatment of obstructive pulmonary diseases. However, spirometry performed in general practice is less reliable than that performed in lung function laboratories and primary care laboratories, so that spirometry performed by the GP personally appears to be less suitable for monitoring purposes. Spirometry is a useful and feasible tool for GP's, providing that test results are adequately integrated within the GP's management of patients with obstructive lung disease. If sufficient attention on quality assurance of spirometry cannot be guaranteed in general practice, lung function laboratories and primary care laboratories may play an important supportive role.

Family Practice↗
PubMed1999

Assessment of a bolus-tracking technique in helical renal CT to optimize nephrographic phase imaging.

PURPOSE: To evaluate a bolus-tracking technique in helical computed tomography (CT) for identifying the onset of the nephrographic phase and to determine the effect of varying the volume and injection rate of contrast material on nephrographic phase onset. MATERIALS AND METHODS: Seventy-five patients underwent bolus tracking of contrast material followed by helical renal CT. In 50 patients, 150 mL of 60% iodinated contrast material (iohexol or iothalamate meglumine) was injected at either 2 mL/sec (25 patients [group 1]) or 3 mL/sec (25 patients [group 2]). In 25 patients who had previously undergone nephrectomy, 100 mL of 60% iodinated contrast material was injected at 3 mL/sec (group 3). Nephrographic phase onset was determined by visually assessing the transition to a homogeneous nephrogram during a monitoring scan series starting 40 seconds after injection. RESULTS: Nephrographic phase onset ranged from 60 to 136 seconds (mean, 89 seconds +/- 17 [+/- SD]). Statistically significant differences in mean onset times were observed among groups 1 (103 seconds +/- 12), 2 (91 seconds +/- 16), and 3 (75 seconds +/- 9) (P < .001). Multiple regression analysis showed patient age, contrast material volume, and injection rate to be independent predictors of nephrographic phase onset. Contrast material volume, patient age, and patient weight were independent predictors of the degree of renal enhancement. CONCLUSION: Nephrographic phase onset is highly dependent on methods of contrast material administration and patient characteristics.

Contrast Media↗
PubMed1999

Renal cyst pseudoenhancement: beam-hardening effects on CT numbers.

PURPOSE: To determine if simple renal cysts may be accurately characterized with helical computed tomography (CT) during peak levels of renal enhancement. MATERIALS AND METHODS: Water-filled "cysts" were suspended in varying concentrations of iodine solution, meant to simulate varying levels of renal enhancement, within an abdominal phantom. Volume-averaging effects were minimized by scanning cylindric 5-30-mm cysts with a helical technique (collimation, 5 mm; pitch, 1:1). Axial and helical techniques were then compared, and volume-averaging effects were evaluated by scanning 10- and 20-mm round cysts with 3-, 5-, and 7-mm collimation at background attenuation levels of 100 and 200 HU. RESULTS: Cylindric cyst attenuation increased consistently with increasing background attenuation. As background attenuation increased by 90 HU, attenuation increased by 11-17 HU in small (5- or 10-mm) cysts, and by 7-9 HU in large (15-30-mm) cysts. As background attenuation increased by 180 HU, attenuation increased by 18-28 HU in small cysts and by 10-15 HU in large cysts. Spherical cyst attenuation differences were maximized when smaller cysts were imaged with larger collimation, which is when volume-averaging effects became apparent. Axial and helical CT numbers did not differ substantially. Computer simulation studies showed that the observed effect could not be explained by beam hardening alone. CONCLUSION: Pseudoenhancement of renal cysts may occur if helical CT is performed during peak renal enhancement. CT algorithm modification may be necessary to correct for this effect, which is likely related to an inadequate algorithmic correction for beam hardening.

Kidney Diseases, Cystic↗
PubMed1998

Hepatic infarction secondary to arterial insufficiency in native livers: CT findings in 10 patients.

PURPOSE: To describe the computed tomographic (CT) appearance of hepatic infarcts resulting from arterial insufficiency in native livers. MATERIALS AND METHODS: The authors retrospectively reviewed the clinical and imaging findings in 10 patients (five men, five women; age range, 28-70 years) with 14 hepatic infarcts seen over 3 years. CT scans were analyzed for infarct appearance, vessel patency, and evolution of infarct pattern over time. RESULTS: Hepatic infarction resulted from hepatobiliary surgery (n = 6), radiologic intervention (n = 3), and celiac occlusion secondary to antiphospholipid syndrome (n = 1). All 14 infarcts were of low attenuation, peripheral, and wedge-shaped. Occluded arterial vessels were identified in eight patients. Follow-up CT revealed infarct diminution with parenchymal atrophy and scarring (n = 5), progressive liquefaction (n = 2), or both parenchymal atrophy and progressive liquefaction (n = 1). CONCLUSION: Sudden interruption of hepatic arterial flow may cause acute native liver infarction. Patients at risk include those with underlying vascular disease who undergo complicated surgical procedures and those undergoing peripheral arterial embolization.

Adult↗
PubMed1998

Contrast media reactions and extravasation: relationship to intravenous injection rates.

PURPOSE: To evaluate the belief that the frequencies of contrast material extravasation and minor, nonidiosyncratic contrast material reactions correlate with intravenous injection rates. MATERIALS AND METHODS: Complications of 6,660 consecutive injections of contrast material for computed tomography were prospectively recorded. Ionic (n = 4,851) or nonionic (n = 1,809) contrast material was injected at 0.5-4.0 mL/sec. The injection rate was 1.9 mL/sec or less in group 1 (n = 2,899), 2.0-2.9 mL/sec in group 2 (n = 2,475), and 3.0-4.0 mL/sec in group 3 (n = 1,286). RESULTS: The extravasation rate (0.6%) did not differ significantly between the groups. The reaction rate (8.4%) also did not differ significantly between the groups. The rate of minor reactions (8.0%) was higher with ionic (9.9%) than nonionic (2.9%) contrast material (relative risk = 3.4). The rate of major reactions (0.4%) did not vary significantly with type of contrast material. The rate of nausea or vomiting (3.8%) did not differ significantly between the groups but was higher with ionic (4.9%) than nonionic (1.1%) contrast material (relative risk = 4.5). The rate of severe warmth (2.1%) was significantly higher in group 3 (2.8%) than group 1 (2.0%) or 2 (1.8%). CONCLUSION: No correlations exist between injection rate and extravasation rate or overall reaction rate.

Case-Control Studies↗
PubMed1998

Diagnostic criteria for fatty infiltration of the liver on contrast-enhanced helical CT.

OBJECTIVE: The purpose of the study was to develop quantitative and qualitative criteria for diagnosing fatty liver on contrast-enhanced helical CT. SUBJECTS AND METHODS: Differential liver-spleen attenuation was evaluated between 80 and 120 sec after injection in 76 patients who underwent contrast-enhanced helical CT. Unenhanced CT images had earlier established fatty liver when the liver minus spleen attenuation difference was less than or equal to -10 H (n = 18). Four observers who had not seen the unenhanced images used contrast-enhanced CT images to assess the presence of fatty liver on a five-point Likert scale, the presence of geographic areas spared from fatty infiltration, and the relative liver-spleen attenuation. The diagnostic accuracies of various imaging criteria were compared using McNemar's chi-square test (for sensitivity and specificity) and analysis of receiver operating characteristic curves. RESULTS: Sensitivity, specificity, and receiver operating characteristic curve areas for observers' qualitative judgments were 54%, 95%, and .91, respectively; for quantitative differential liver-spleen attenuation (80-100 sec; -20.5 H discriminatory value), the values were 86%, 87%, and .94, respectively; and for quantitative differential liver-spleen attenuation (101-120 sec; -18.5 H discriminatory value), the values were 93%, 93%, and .98, respectively. Differential liver-spleen attenuation was time-dependent; overlap was noted between healthy subjects and patients with fatty liver. Qualitatively, geographic sparing was highly specific (94%) for fatty liver, whereas liver attenuation greater than or equal to spleen attenuation excluded fatty liver in all but one case. CONCLUSION: Although quantitative and qualitative criteria for diagnosing fatty liver on helical CT can be determined, they are protocol-specific. Limited unenhanced hepatic CT remains the optimal technique for detection of fatty infiltration of the liver.

Contrast Media↗