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Jan De Maeseneer

Publications and source records attributed to Jan De Maeseneer.

15 recordsLinked to original sources
PubMed2006

The International Classification of Primary Care (ICPC-2): an essential tool in the EPR of the GP.

The International Classification of Primary Care (ICPC) has become a standard all over the world. It became a standard tool to classify the important elements in the Electronic Patient Record (EPR) of the GP: reasons for encounter (RFE) reflecting the patient's view, process of care (decision, action, intervention or plans) reflecting the care process, and the assessment (diagnosis or health issue) reflecting the doctor's view. ICPC-2 is fully compatible with structuring data in the episode of care model and it's reflecting the essential elements of each patient/provider encounter. To implement ICPC-2 in the EPR a Thesaurus has been developed in Belgium with double encoded clinical labels. The implementation is now mandatory for labeled EPR systems in Belgium. The use of ICPC 2 ay improve the accessibility and use of on-line Expert systems and Guidelines.

Belgium↗
PubMed2005

Teaching communication skills to medical students, a challenge in the curriculum?

INTRODUCTION: As communication skills become more and more important in medical practice, the new medical curriculum at Ghent University (1999) implemented a communication curriculum. METHOD: Communication training or experiences in 'real life' settings are provided every year of the medical curriculum. The training starts with simple basic skills but gradually slips into medical communication or consultation training and results in communication in different contextual situations or with special groups of patients. Rehearsal is important and seen as inevitable. Poorly performing students get extra training. Several didactical methods are used: the skills are demonstrated by means of videotapes and paper cases of patient stories. Skills are trained in small groups (10-15 students), with focus on role-playing with colleague students or simulated patients (SP). Videotapes of real consultations give an idea of the performance of each student. Every year the students are assessed by means of an OSCE (objective structured clinical examination). CONCLUSION: After 6 years of experience with the new curriculum, several remarks and questions need to be answered. Small group training gives a huge workload and with different trainers discrepancies between groups can appear. Choosing the most suitable trainer for communication skills is not easy; several options are available: specialists in communication like psychologists with interest in medical practice, GPs with interest in medical communication, medical specialists for communication topics concerning medical problems within their domain. As the most important didactical approach lies in practising the skills, the selection and training of simulated patients remains a challenge. PRACTICE IMPLICATION: A communication continuum during the whole curriculum seems to be worthwhile. Students with specific communicative problems are detected early, remediation is provided. Rehearsal every year seems to lead to better acquisition. The most positive point is that communication is embedded in a global patient-, student- and community-oriented curriculum and that communication skills are seen as core elements of good doctoring.

Belgium↗
PubMed2005

Study on the reproducibility of the Waters' views of the maxillary sinuses.

OBJECTIVE: This study intended to investigate the reproducibility of the Waters' view for maxillary sinusitis and to define its place in clinical practice. MATERIALS AND METHOD: Radiographs of 80 maxillary sinuses of patients with suspected acute sinusitis were read by 6 radiologists, 6 ENT surgeons, 6 general practitioners (GPs). Interobserver agreement was calculated using the kappa statistic. RESULTS: Agreement was good (kappa = 0.63; 95% CI 0.58-0.68) between radiologists when the criteria used to define acute sinusitis were "important mucosal swelling, air-fluid level or complete opacity". When the criteria "air-fluid level or complete opacity" were used, agreement was fair (kappa 0.39; 95% CI 0.35-0.44). Between ENT-surgeons kappas were respectively 0.58 (95% CI 0.53-0.63) and 0.37 (95% CI 0.32-0.42). Between GPs kappas were respectively 0.30 (95% CI 0.25-0.35) and 0.28 (95% CI 0.23-0.33). CONCLUSION: The reproducibility of Waters' views of the maxillary sinuses is best when the interpretation is performed by radiologists or ENT surgeons, and when criteria for sinusitis are: important mucosal swelling, air fluid level or complete opacity. The good interobserver agreement combined with the known high negative predictive value of these diagnostic criteria makes the Waters' view only useful for ruling out acute sinusitis.

Humans↗
PubMed2004

Is the communicative behavior of GPs during the consultation related to the diagnosis? A cross-sectional study in six European countries.

This study explores the relation between the diagnosis made by the general practitioner (GP) and his or her communicative behavior within a consultation, by means of the analysis of 2095 videotaped consultations of 168 GPs from six countries participating in the Eurocommunication study. The doctors' diagnoses were coded into ICPC chapters and merged into seven clinically relevant diagnostic clusters. The communicative behavior was gauged by means of the Roter interaction analysis system (RIAS). We found the most important differences for consultations about psychosocial problems as compared to all other diagnostic categories. In these consultations, doctors show more affective behavior, are more concerned about having a good relationship with their patients, ask more questions and give less information than in other consultations. The percentages of utterances in the other diagnostic categories were pretty similar. The communicative behavior of doctors reflects a global pattern in every consultation. This pattern is the most stable for affective behavior (social talk, agreement, rapport building and facilitation). Within instrumental behavior (the other categories), the directions and the information the doctor gives are adapted to the problems presented.

Adult↗
PubMed2004

Consultation in general practice: a standard operating procedure?

The objectives of this study were to describe the features of consultation within general practice with special attention to the differences between short, moderate and long consultations. An analysis of 2801 videotaped consultations of 183 General Practitioners from six countries participating in the Eurocommunication Study was made. The communicative behaviour was gauged by means of the Roter Interaction Analysis System. The consultation can be seen as a "standard operating procedure" consisting of 8% social behaviour, 15% agreement, 4% rapport building, 10% partnership building, 11% giving directions, 28% giving information, 14% asking questions and 7% counselling. A short consultation can be described as an encounter with a little bit of social behaviour to set the contact, medical questioning, giving directions for the further consultation and advises in order to solve the problem(s) mentioned. In a long consultation doctors take more time for a social talk, they give more attention to the relation or contact with the patient, they listen more extensively, especially to psychosocial problems, and they give more information.

Belgium↗
PubMed2002

Consultation length in general practice: cross sectional study in six European countries.

OBJECTIVES: To compare determinants of consultation length discussed in the literature with those found in consultations with general practitioners from different European countries; to explore the determinants of consultation length, particularly the effect of doctors' and patients' perceptions of psychosocial aspects. DESIGN: Analysis of videotaped consultations of general practitioners from the Eurocommunication study and of questionnaires completed by doctors and by patients. SETTING: General practices in six European countries. PARTICIPANTS: 190 general practitioners and 3674 patients. RESULTS: In a multilevel analysis with three levels (country, general practitioner, and patient), country and doctor variables contributed a similar amount to the total variance in consultation length (23% and 22%, respectively) and patient variables accounted for 55% of the variance. The variables used in the multilevel analysis explained 25% of the total variation. The country in which the doctor practised, combined with the doctors' variables, was as important for the variance in consultation length as the variation between patients. Consultations in which psychosocial problems were considered important by the doctor and the patient lasted longer than consultations about biomedical problems only. The doctor's perception had more influence in this situation than the patient's. Consultation length is influenced by the patients' sex (women got longer consultations), whether the practice was urban or rural, the number of new problems discussed in the consultation (the more problems the longer the consultation), and the patient's age (the older the patient the longer the consultation). As a doctor's workload increased, the length of consultations decreased. The general practitioner's sex or age and patient's level of education were not related to the length of consultation. CONCLUSION: Consultation length is determined by variables related to the doctor and the doctor's country as well as by those related to patients. Women consulting in an urban practice with problems perceived as psychosocial have longer consultations than other patients.

Adult↗
PubMed2002

Medical students' personality characteristics and academic performance: a five-factor model perspective.

OBJECTIVES: This study investigates: (1) which personality traits are typical of medical students as compared to other students, and (2) which personality traits predict medical student performance in pre-clinical years. DESIGN: This paper reports a cross-sectional inventory study of students in nine academic majors and a prospective longitudinal study of one cohort of medical students assessed by inventory during their first preclinical year and by university examination at the end of each pre-clinical year. SUBJECTS AND METHODS: In 1997, a combined total of 785 students entered medical studies courses in five Flemish universities. Of these, 631 (80.4%) completed the NEO-PI-R (i.e. a measure of the Five-Factor Model of Personality). This was also completed by 914 Year 1 students of seven other academic majors at Ghent University. Year end scores for medical students were obtained for 607 students in Year 1, for 413 in Year 2, and for 341 in Year 3. RESULTS: Medical studies falls into the group of majors where students score highest on extraversion and agreeableness. Conscientiousness (i.e. self-achievement and self-discipline) significantly predicts final scores in each pre-clinical year. Medical students who score low on conscientiousness and high on gregariousness and excitement-seeking are significantly less likely to sit examinations successfully. CONCLUSIONS: The higher scores for extraversion and agreeableness, two dimensions defining the interpersonal dynamic, may be beneficial for doctors' collaboration and communication skills in future professional practice. Because conscientiousness affects examination results and can be reliably assessed at the start of a medical study career, personality assessment may be a useful tool in student counselling and guidance.

Belgium↗
PubMedDate not supplied

The independent impact of household- and neighborhood-based social determinants on early childhood caries: a cross-sectional study of inner-city children.

This study examined the relationship between early childhood caries (ECC) and measures of socioeconomic status as environmental determinants of oral health inequalities. Dental caries and quality of oral hygiene were reported on 384 young inner-city children (24-35 months) by clinical examination. Early childhood caries was diagnosed in 18.5% of children. Ethnicity (P < 0.001) and neighborhood (P < 0.001) were the social variables significantly predictive of ECC in a logistic regression model. Living in a deprived neighborhood and the mother being of East European descent were the social variables with strongest association with ECC. These variables can be considered adequate criteria to identify groups at risk within the overall population.

Belgium↗
PubMedDate not supplied

Predicting prognosis and effect of antibiotic treatment in rhinosinusitis.

PURPOSE: In evaluating complaints suggestive of rhinosinusitis, family physicians have to rely chiefly on the findings of a history, a physical examination, and plain radiographs. Yet, evidence of the value of signs, symptoms, or radiographs in the management of these patients is sparse. We aimed to determine whether clinical signs and symptoms or radiographic findings can predict the duration of the illness, the effect of antibiotic treatment, or both. METHODS: We analyzed data from 300 patients with rhinosinusitis-like complaints participating in a randomized controlled trial comparing amoxicillin with placebo. We used Cox regression analysis to assess the association between the presence at baseline of rhinosinusitis signs and symptoms or an abnormal radiograph and the subsequent course of the illness. We then tested for interactions to assess whether the presence of any of these findings predicted a beneficial effect of antibiotic treatment. RESULTS: Two factors at baseline were independently associated with a prolonged course of the illness: a general feeling of illness (hazard ratio = 0.77, 95% confidence interval, 0.60-0.99) and reduced productivity (hazard ratio = 0.68, 95% confidence interval, 0.53-0.88). Neither typical sinusitis signs and symptoms nor abnormal radiographs had any prognostic value. Prognosis remained unchanged whether or not patients were treated with antibiotics, no matter what symptoms patients had at baseline. CONCLUSIONS: In a large group of average patients with rhinosinusitis, neither the presence of typical signs or symptoms nor an abnormal radiograph provided information with regard to the prognosis or the effect of amoxicillin. The time to recovery was longer in patients who felt ill at baseline or who did not feel able to work, but the course of their illness was not influenced by antibiotic treatment.

Acute Disease↗
PubMedDate not supplied

Are sore throat patients who hope for antibiotics actually asking for pain relief?

PURPOSE: Antibiotics are still overprescribed for self-limiting upper respiratory tract infections such as acute sore throat, and physicians mention patient's desire for antibiotics as a driving force. We studied patients' concerns when visiting their family physician for acute sore throat, more specifically the importance they attach to antibiotic treatment and pain relief. METHODS: Family physicians in 6 peer groups in Belgium participated in an observational postvisit questionnaire survey. Patients aged 12 years and older making an office visit for acute sore throat were invited to indicate the importance of different reasons for the visit. RESULTS: Sixty-eight family physicians provided data from 298 patients. The 3 most frequently endorsed reasons for visiting the physician were examination to establish the cause of the symptoms, pain relief, and information on the course of the disease. Hopes for an antibiotic ranked 11th of 13 items. Patients who considered antibiotics very/rather important valued pain relief significantly more than patients who considered them little/not important (P <.001). Patients who hoped for antibiotics felt more unwell (P <.001), had more faith in antibiotics to speed recovery (P <.001), and were less convinced that sore throat was a self-limiting disease (P <.012). A multivariate model, adjusted for age, sex, and educational status, showed that the desire for pain relief is a strong predictor of the hope to receive a prescription for antibiotics. CONCLUSION: Our study suggests that patients with acute sore throat and who hope for antibiotics may in fact want treatment for pain. Trials are needed to test whether exploring patients' expectations about pain management and offering adequate analgesia can assist physicians in managing sore throats without prescribing antibiotics.

Adolescent↗
PubMedDate not supplied

Knowledge and management of scabies in general practitioners and dermatologists.

Scabies is an infectious skin disease with an increasing incidence during the past decade. A survey was conducted among general practitioners (GPs) and dermatologists in the region of Ghent, Belgium, to explore their knowledge on scabies. Information on the treatment advice given and the frequency of reporting scabies to the Health Inspection was also collected. The scores on the knowledge test were of an acceptable level in both GPs and dermatologists (median score 59% and 79% respectively). We found that profession (dermatologist versus GP), the number of years of experience and the estimated number of scabies patients per year had a significant effect on this score. Permethrin cream, currently regarded as the standard treatment, is prescribed as the only treatment for scabies by half of the GPs and dermatologists. Almost 50% of the GPs and dermatologists indicated they rarely or never report scabies to the Health Inspection. As a result the correct incidence of scabies in Belgium, as in many other countries, is not known.

Adult↗
PubMedDate not supplied

The importance of socio-economic status and individual characteristics on the prevalence of head lice in schoolchildren.

Pediculosis is a common infestation in schoolchildren but little is known about the factors influencing its prevalence. The aim of this study was to determine the prevalence of head lice in schoolchildren in Ghent and to investigate the independent association between individual characteristics of the child, socio-economic status (SES) of the family and head lice. The prevalence of head lice at baseline and 14 days after treatment advice was determined by the wet combing method in a total of 6,169 schoolchildren age 2.5 to 12 years from Ghent (Belgium). Age, sex, educational level and hair characteristics of the child, SES of the family, and number of children in the family was collected by the school health department. The prevalence of head lice was 8.9%. The only statistically significant factors at the child level are SES, the number of children in the family, hair length and hair colour. Treatment failure was recorded in 41% of the children positive at baseline screening and was significantly related to hair colour and SES. This study demonstrated that the prevalence of head lice is determined by clustering of children rather than by characteristics of the child. The management of head lice should take a community-based approach equally involving families, schools, health care professionals and the government.

Animals↗
PubMedDate not supplied

Determinants of early childhood caries in a group of inner-city children.

OBJECTIVE: This study aimed to determine the prevalence of early childhood caries (ECC) and severe early childhood caries (s-ECC) in inner-city children in Ghent, Belgium, and to investigate the independent impact of its determinants. METHOD AND MATERIALS: In a non-randomized cross-sectional research design, all children between 24 and 34 months of age attending the final consultation at a participating Child and Family Health Clinic were included (n = 385). Data on oral hygiene and caries were collected by oral examination. Caries prevalence and oral hygiene were determined according to established criteria. Data on oral health habits and socioeconomic status were obtained by a validated questionnaire. All analyses were performed with ECC and s-ECC as response variables. RESULTS: The mean DMFS was 0.83 (SEM = 0.14). ECC was diagnosed in 18.5% of the children and s-ECC was found in 12.2%. Treatment need was 100%. From the multiple regression analysis it became clear that ethnicity and neighborhood significantly determined ECC. From all oral health-related behavioral variables, only daily use of a bottle with sweetened drinks other than milk or water, frequency of brushing, and quality of oral hygiene as expressed by Plaque Index scores remained significantly associated with ECC. CONCLUSION: Children whose mothers had an Eastern European nationality at birth and who live in a deprived neighborhood, daily use a bottle with sweetened drinks other than milk or water, brush less than once a day, and have plaque are at higher risk for ECC and s-ECC.

Belgium↗