Biomedical subjects

Johan van der Lei

Publications and source records attributed to Johan van der Lei.

28 records · Page 2Linked to original sources

PubMed2005

User requirements rating and knowledge-level of general practitioners at the start of CholGate - a lipid management decision support project.

In the CholGate project we performed a preliminary study evaluating user requirements and knowledge level on lipid management in 40 primary care practices in The Netherlands. Practitioners rated speed, usability and completeness as important. We hope to show that the knowledge level of physicians regarding lipid management can be passively increased from its current levels by an integrated decision support system.

Attitude to Computers↗

PubMed2004

Antipsychotics and the risk of sudden cardiac death.

BACKGROUND: Antipsychotics have been associated with prolongation of the corrected QT interval and sudden cardiac death. Only a few epidemiological studies have investigated this association. We performed a case-control study to investigate the association between use of antipsychotics and sudden cardiac death in a well-defined community-dwelling population. METHODS: We performed a population-based case-control study in the Integrated Primary Care Information (IPCI) project, a longitudinal observational database with complete medical records from 150 general practitioners. All instances of death between January 1, 1995, and April 1, 2001, were reviewed. Sudden cardiac death was classified based on time between onset of cardiovascular symptoms and death. For each case, up to 10 random controls were matched for age, sex, date of sudden death, and practice. Exposure at the index date was categorized as 3 mutually exclusive groups of current use, past use, and nonuse. RESULTS: The study population comprised 554 cases of sudden cardiac death. Current use of antipsychotics was associated with a 3-fold increase in risk of sudden cardiac death. The risk of sudden cardiac death was highest among those using butyrophenone antipsychotics, those with a defined daily dose equivalent of more than 0.5 and short-term (</=90 days) users. The association with current antipsychotic use was higher for witnessed cases (n = 334) than for unwitnessed cases. CONCLUSIONS: Current use of antipsychotics in a general population is associated with an increased risk of sudden cardiac death, even at a low dose and for indications other than schizophrenia. Risk of sudden cardiac death was highest among recent users but remained elevated during long-term use.

Adolescent↗

PubMed2003

OpenSDE: Row modeling applied to generic structured data entry.

Clinicians generally record medical narrative data, such as current complaints, physical examination, and progress notes, as free text in paper-based medical records. The medical narrative involves heterogeneous and detailed data that include the description of (multiple) occurrences of medical findings or symptoms that may progress over time. Structured, electronic recording of narrative data would facilitate the use of these data for research. The authors' OpenSDE application supports clinicians with the structured recording of narrative data in both research and care settings. Data entry is enabled using forms that are generated using domain-specific trees of medical concepts. For data storage, the authors have expanded the traditional row modeling methodology with additional columns that allow structured representation of medical narratives including descriptions of findings, multiple occurrences of findings, and the progression of findings over time.

Information Storage and Retrieval↗

PubMed2003

AsthmaCritic: issues in designing a noninquisitive critiquing system for daily practice.

The noninquisitive critiquing system, AsthmaCritic, uses routinely recorded electronic patient data to select and analyze records of patients with asthma or chronic obstructive pulmonary disease (COPD). The system generates critiquing comments and adds these comments to the patient record. The system was developed by using and expanding an existing generic critiquing system. After a brief overview of the system, this report focuses on the authors' design choices in light of existing literature and the issues that underlie these design choices. Currently, AsthmaCritic is used by primary care physicians and is undergoing clinical evaluation.

Asthma↗

PubMed2003

Influenza vaccination in community-dwelling elderly: impact on mortality and influenza-associated morbidity.

BACKGROUND: Influenza-related morbidity and mortality have been extensively studied with hospital and reimbursement data. However, little is known about the effectiveness of the annual vaccination programs in generally healthy community-dwelling elderly. The objective of our study was to investigate the effectiveness of influenza vaccination in community-dwelling elderly during the 1996 to 1997 influenza epidemic. METHODS: We performed a population-based cohort study using the computerized Integrated Primary Care Information database in the Netherlands. Subjects who were 65 years and older in 1996 with a permanent status in a practice in the source population were considered eligible for study participation. Two cohorts were defined on the basis of vaccination status. We estimated and compared all-cause mortality, pneumonia, and clinical influenza infection rates between the cohorts. RESULTS: Influenza vaccination was associated with a significant reduction of morbidity and mortality in vaccinated elderly (relative risk [RR], 0.72; 95% confidence interval [CI], 0.60-0.87). Influenza infections decreased significantly in the vaccinated population (RR, 0.48; 95% CI, 0.26-0.91). Mortality was reduced significantly in elderly with comorbidity (RR, 0.67; 95% CI, 0.48-0.94). The risk reduction for pneumonia was nonsignificant (RR, 0.77; 95% CI, 0.55-1.07) but was temporally related to the peak influenza activity. CONCLUSIONS: In this study, influenza vaccination was associated with decreased mortality and influenza infections in community-dwelling elderly. Our results indicate that, in a season of mild influenza activity and good antigenic match between vaccine strains and circulating strains, influenza vaccination reduced mortality in the vaccinated population. Our data support an annual vaccination strategy for all community-dwelling elderly.

Age Distribution↗

PubMed2003

Design considerations for a personalised patient education system.

Patient education is a significant factor in the provision of health care services, contributing to improved disease management and health care outcomes. In order to be most effective, patient education should be adapted to the characteristics of the individual recipient. Computer-based approaches have been explored as a possible means of achieving this goal. The success and capabilities of the resulting applications have been restricted by the absence of a direct link to patient data and the reliance on locally produced written material, which is expensive to produce, update and tailor. In our research project STructured Evaluated Personalized Patient Support (STEPPS), we are investigating the potential of a novel strategy for personalized or tailored patient education, based on the integration of electronic patient record data and material derived from online health information and knowledge resources. In this paper we present an overview of the pertinent technical issues and the way we have addressed them in the context of our development work in the domain of burn care. Further, we discuss how the choices made in the design of the system interrelate with the considerations for its implementation in health care practice settings.

Abstracting and Indexing↗

PubMed2002

Information and communication technology in health care: do we need feedback?

Applying information and communication technology (ICT) to a given medical domain is not merely adding a new technique. When applied to a medical domain, ICT has the potential to radically change processes in that domain. In their paper 'Health care in the information society: a prognosis for the year 2013' Haux and co-workers provide us with a set of predictions based on progress in three main areas: (1). patient-centred recording and use of medical data for collaborative care; (2). process-integrated decision support; and (3). comprehensive use of patient data for research and health care reporting. We complement their theses by predicting some of the feedback mechanisms that will develop as ICT is shaping health care. Feedback is return to the input of a part of the output of a mechanism; this part of the input constituting information that reports discrepancies between intended and actual operation and leads to a self-correcting action that can be utilised. We discuss feedback in the areas Haux identifies: the patient record, decision support, and the use of data for research and health care reporting. For each of these domains, we will discuss the output that serves as input, the discrepancies discovered, and the self-correction that will or should follow.

Cooperative Behavior↗

PubMed2002

Feasibility of AsthmaCritic, a decision-support system for asthma and COPD which generates patient-specific feedback on routinely recorded data in general practice.

BACKGROUND: Introducing decision-support systems as a tool to stimulate the dissemination of clinical guidelines in daily practice has been disappointing. Researchers have argued that integration of such systems with clinical practice is a prerequisite for acceptance. The big question concerns the feasibility of a true integration--if only routinely recorded data are used for such a system, can patient-specific feedback be produced? OBJECTIVE: The aim of this study was to assess the feasibility of generating patient-specific feedback based on routinely recorded data in general practice by AsthmaCritic, a decision-support system for asthma and chronic obstructive pulmonary disease (COPD). METHODS: We built the decision-support system AsthmaCritic and assessed its ability to detect asthma and COPD patient records and generate patient-specific feedback by retrospective analysis of routinely recorded data in 103 713 electronic patient records from primary care practices. We grouped feedback into categories of comments by age group (<12 years and > or =12 years). The main outcome measures were the number and percentage of "triggered" (selected) asthma and COPD patient records, and the number and percentage of records on which AsthmaCritic produced at least one feedback comment during the 1-year study period, by category of comments. RESULTS: AsthmaCritic detected 8784 (8.5%) asthma and COPD patient records. During the study period, AsthmaCritic generated 255 664 feedback comments (mean 3.4 per patient visit). The most frequently generated category of comments in the case of patients aged > or =12 years was "non-compliant prescription" (23.7%), whereas the most frequent category in the case of patients <12 years was "non-compliant route" (31.1%). CONCLUSIONS: This study shows that, using routinely recorded data only, AsthmaCritic is able to detect asthma and COPD patient records for further analysis and to produce patient-specific feedback.

Adolescent↗

PubMed2002

Compliance of general practitioners with a guideline-based decision support system for ordering blood tests.

BACKGROUND: Guidelines are viewed as a mechanism for disseminating a rapidly increasing body of knowledge. We determined the compliance of Dutch general practitioners with the recommendations for blood test ordering as defined in the guidelines of the Dutch College of General Practitioners. METHODS: We performed an audit of guideline compliance over a 12-month period (March 1996 through February 1997). In an observational study, a guideline-based decision support system for blood test ordering, BloodLink, was integrated with the electronic patient records of 31 general practitioners practicing in 23 practices (16 solo). BloodLink followed the guidelines of the Dutch College of General Practitioners. We determined compliance by comparing the recommendations for test ordering with the test(s) actually ordered. Compliance was expressed as the percentage of order forms that followed the recommendations for test ordering. RESULTS: Of 12 668 orders generated, 9091 (71%) used the decision-support software rather than the paper order forms. Twelve indications accounted for >80% of the 7346 order forms that selected a testing indication in BloodLink. The most frequently used indication for test ordering was "vague complaints" (2209 order forms; 30.1%). Of the 7346 order forms, 39% were compliant. The most frequent type of noncompliance was the addition of tests. Six of the 12 tests most frequently added to the order forms were supported by revisions of guidelines that occurred within 3 years after the intervention period. CONCLUSIONS: In general practice, noncompliance with guidelines is predominantly caused by adding tests. We conclude that noncompliance with a guideline seems to be partly caused by practitioners applying new medical insight before it is incorporated in a revision of that guideline.

Blood Chemical Analysis↗

PubMedDate not supplied

Cross-sectional analysis of guidelines on cardiovascular disease risk factors: going to meet the inconsistencies.

OBJECTIVE: To identify the possible inconsistency of statements among the practice guidelines of the Dutch College of General Practitioners (DCGP) with respect to the management of risk factors for cardiovascular disease (CVD). METHODS: Cross-sectional analysis of all electronically available DCGP practice guidelines dealing with CVD risk factor management for statement inconsistencies and reference inconsistencies. RESULTS: Six DCGP guidelines out of 74 electronically available guidelines had either CVD or CVD risk factors as the subject of the guideline. Eight statement inconsistencies-were found, and for each statement inconsistency, a reference inconsistency was present. CONCLUSIONS: Given that inconsistencies were found, the authors recommend that organizations that maintain a set of guidelines update the guidelines using a cross-sectional analysis of guidelines. Inconsistencies between guidelines might lead to physicians being unintentionally noncompliant with guideline recommendations.

Cardiovascular Diseases↗