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J J van Everdingen

Publications and source records attributed to J J van Everdingen.

At least 19 recordsLinked to original sources
PubMed1992

[Diagnostic management in suspicion of pulmonary embolism: results of a survey among Dutch internists and pulmonologists].

To gain insight into the incidence of suspected pulmonary embolism in the Netherlands and to evaluate the diagnostic strategy and therapeutic consequences in this patient population, a questionnaire was sent to all practising medical and pulmonary specialists (members of the respective associations). The number of patients admitted with suspected pulmonary embolism in the previous month and the diagnostic and therapeutic management in the last patient were requested. A reply was received from 698 internists and 272 pulmonologists (total response 73%). The management by the two specialist groups was not different. In the previous month 970 respondents treated 2245 patients for suspected pulmonary embolism. Extrapolated this means that 2.6 patients per 1000 inhabitants in the Netherlands are suspected of pulmonary embolism each year. Of the respondents, 95% had facilities to obtain a perfusion-ventilation scan. Of this group, 97% performed a perfusion scan when pulmonary embolism was suspected. A normal scan was found in 16% of the patients. A ventilation scan was performed in 71% of the patients with an abnormal perfusion scan result. Of all patients with an abnormal perfusion scan, 87% were treated with anticoagulants. The ventilation scan had little influence on this decision. The clinical suspicion of pulmonary embolism is a frequent clinical problem. The fact that of all patients with an abnormal perfusion scan 87% are treated, indicates overtreatment. The diagnosis of pulmonary embolism needs to be improved.

Angiography↗
PubMed1992

Liver biopsy versus ultrasound in methotrexate-treated psoriasis: a decision analysis.

Before starting methotrexate therapy for cases of recalcitrant psoriasis, a liver biopsy has been usual in order to exclude cirrhosis and moderate or severe fibrosis, which are contraindications for methotrexate treatment. As mortality and morbidity of liver biopsy are not negligible, and as this invasive procedure is unpleasant for the patient and urges clinical admission, we evaluated the possibility of ruling out severe liver pathology by means of ultrasonography, which we compared to liver biopsy. We made this comparison by means of a decision tree. The advantages of this analysis are the clear definition of the decision problem and its alternatives, and the possibility of calculating the risk of each alternative, thus being able to choose the best diagnostic method. In this study, the results of various research groups are discussed, in which liver biopsy and liver ultrasound were compared. In our decision tree we used some of these results and other assumptions, based on comparable studies. We varied the biopsy mortality and the sensitivity of ultrasound to show the change in the risk of each alternative. Our analysis shows that the differences of expected values between the liver biopsy branch and the ultrasonography branch are relatively small. Therefore, we advise each center, which has at its disposal a specialist in liver ultrasonography, to re-evaluate its guidelines with regard to the detection of severe liver pathology before starting methotrexate for the treatment of psoriasis.

Algorithms↗
PubMed1991

[Consensus early treatment with zidovudine].

The aim was to reach national consensus on the moment early treatment with the antiretroviral drug zidovudine should be started and on the dosing schedule to be used. On the initiative and under the auspices of the National AIDS Therapy Evaluation Centre a consensus meeting of Dutch AIDS treatment specialists was organised on March 6, 1991. A number of expert-speakers made recommendations on the basis of currently available information. These were amended in a plenary discussion. Subsequently the participants could comment upon a draft consensus document. Premises were that the starting point of treatment should be easily applicable and that the moment chosen should be neither too early nor too late in the course of HIV infection. The zidovudine dose had to be an effective one, and the dosing schedule user-friendly. The consensus was that zidovudine should be started in asymptomatic HIV-infected persons at a peripheral blood CD4+ cell count less than or equal to 0.3 x 10(9)/l. In the presence of additional laboratory indicators of a poor prognosis and in persons with early clinical symptoms of HIV infection, it was preferred to start treatment at a CD4+ cell count less than or equal to 0.4 x 10(9)/l. In view of the natural fluctuation in the number of CD4+ cells it was felt to be injudicious to act upon a single count. The recommended zidovudine dose is 200 mg 3 times daily. In case of serious toxicity the dose should be lowered to 100 mg 3 times daily, although for this dose no long-term efficacy data are available.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Different disciplines, different diagnoses?--A survey among participants of a consensus conference on dementia].

It is hardly known to what extent consensus criteria for dementia are adhered to in clinical practice. An inquiry was held among the participants of the Dutch consensus meeting on dementia to investigate this point. 85 clinicians diagnosed the case descriptions of 10 patients with cognitive dysfunctions. The inquiry was split into two parts, i.e. before and after the meeting. There was no difference between the two parts in the level of consensus. There was not difference between the disciplines in syndrome diagnoses. However, with regard to etiology, significant differences existed between the specialties. Furthermore, the agreement increased with the severity of the cognitive disturbances. In cases where depressive symptoms coexisted, the diagnosis was more often in error. The nature of the diagnoses appeared to be dependent on the discipline of the diagnostician. This study underlines the necessity of a multidisciplinary diagnostic approach based on well accepted criteria.

Aged↗
PubMed1990

[Inventory and comparison of guidelines for antibiotic utilization in Dutch hospitals].

In 1976 the Dutch Health Council advised hospitals to formulate guidelines for use of antibiotics. These guidelines and their use should improve the quality of care in terms of medical effectiveness and cost-effectiveness. In 1988 the Peer Review Council held a survey among all (140) Dutch hospitals to collect data about these guidelines. Thirty-seven sets of guidelines used in 71 hospitals were obtained. We analysed these sets of guidelines as to the following general aspects: the status of the guidelines in the hospitals, the problem-oriented approach, the topics dealt with in the guidelines and the authors of the guidelines. Four specific aspects related to rational use of antibiotics were analysed as well: the use of cephalosporin, the use of different antibiotics for prophylaxis and therapy and the cost-effectiveness of antibiotic treatment in relation to urosepsis. Results of these analyses show that guidelines are too often formulated in a noncommittal way and that there is a need for a more functional registration system to link information about the clinical working diagnoses, the bacteria isolated and the sensitivity to the antibiotics used. These linkages are essential for feedback to clinicians, microbiologists and pharmacists and a prerequisite for management of the quality of care with respect to use of antibiotics.

Anti-Bacterial Agents↗
PubMed1989

[Evaluation consensus melanoma of the skin based on pathologic-anatomic reports].

On September 15, 1984 a consensus development conference on cutaneous melanoma was held. The consensus statement included explicit guidelines on the management of patients with primary and metastatic melanoma. For evaluation of the post-conference compliance among clinicians, 383 histopathological reports prepared by 19 pathology laboratories in 1986 and 384 reports dating from 1988 were analysed and the data compared with those in 324 reports dating from 1983, one year before the consensus conference. The present study is confined to the details of the histopathological description and the type of diagnostic procedure conducted by the physician. There was a substantial increase in the percentages of cases in which Breslow thickness was reported (1983: 83%, 1986: 91%, 1988: 97%). Also, other microscopical parameters were more detailed after the consensus conference.

Humans↗