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Biomedical subjects

Joris P J Slaets

Publications and source records attributed to Joris P J Slaets.

15 recordsLinked to original sources
PubMed2006

Collaboration with general practitioners: preferences of medical specialists--a qualitative study.

BACKGROUND: Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates medical specialists to initiate and continue participating with GPs in new collaborative care models. The following question is addressed in this study: What motivates medical specialists to initiate and sustain new models for collaborating with GPs? METHODS: We conducted semi-structured interviews with eighteen medical specialists in the province of Groningen, in the North of The Netherlands. The sampling criteria were age, gender, type of hospital in which they were practicing, and specialty. The interviews were recorded, fully transcribed, and analysed by three researchers working independently. The resulting motivational factors were grouped into categories. RESULTS: 'Teaching GPs' and 'regulating patient flow' (referrals) appeared to dominate when the motivational factors were considered. In addition, specialists want to develop relationships with the GPs on a more personal level. Most specialists believe that there is not much they can learn from GPs. 'Lack of time', 'no financial compensation', and 'no support from colleagues' were considered to be the main concerns to establishing collaborative care practices. Additionally, projects were often experienced as too complex and time consuming whereas guidelines were experienced as too restrictive. CONCLUSION: Specialists are particularly interested in collaborating because the GP is the gatekeeper for access to secondary health care resources. Specialists feel that they are able to teach the GPs something, but they do not feel that they have anything to learn from the GPs. With respect to professional expertise, therefore, specialists do not consider GPs as equals. Once personal relationships with the GPs have been established, an informal network with incidental professional contact seems to be sufficient to satisfy the collaborative needs of the specialist. The concerns seem to outweigh any positive motivational forces to developing new models of collaborative practice.

Adult↗
PubMed2006

Operationalizing integrated care on a clinical level: the INTERMED project.

During the last 10 years the INTERMED method has been developed as a generic method for the assessment of bio-psychosocial health risks and health needs and for planning of integrated treatment. The INTERMED has been conceptualized to counteract divisions and fragmentation of medical care. Designed to enhance the communication between patients and the health providers as well as between different professions and disciplines, the INTERMED is a visualized, action-oriented decision-support tool. This article presents various aspects of the INTERMED, such as its relevance, description, scoring, the related patient interview and treatment planning, scientific evaluation, implementation, and support for the method.

Decision Support Systems, Clinical↗
PubMed2006

Vulnerability in the elderly: frailty.

In scenarios that predict the future of health service delivery in the Western world, the rapid increase in frail elderly patients is seen as one of the major challenges of health care in addition to the care of the chronic medically ill. In this article the relation between age, frailty, comorbidity, and disability is elaborated further, a method to detect frail patients quickly is introduced, and its relation to complexity is explored. An argument for patient-tailored integrated care in frail elderly patients is made. At the same time, the argument will be made that standard evidence-based care can be delivered for patients who have a negative screen on frailty.

Aged↗
PubMed2005

The effectiveness of a bibliotherapy in increasing the self-management ability of slightly to moderately frail older people.

OBJECTIVE: Self-management ability (SMA) is the ability to obtain those resources necessary for the production of well-being. With age, SMA becomes increasingly important, if one has a large variety of resources, physical and psychosocial losses due to the aging process can be substituted or compensated for. This study examined whether an increase in SMA would ensure sustainable levels of positive well-being among slightly to moderately frail older people. METHODS: A bibliotherapy was developed to increase the SMA of slightly to moderately frail older people, and to help these persons to sustain a certain level of well-being. The effectiveness of this bibliotherapy was examined by comparing the SMA, mastery, and subjective well-being of 97 older people participating in the bibliotherapy to those of 96 older people in a delayed-treatment control condition. RESULTS: The bibliotherapy resulted in a significant increase in SMA and mastery compared to the delayed-treatment control condition, and for SMA, this effect still existed 6 months after the intervention. The increase in SMA among older people who received the bibliotherapy prevented a decline in well-being as expected, but only in the short-term. CONCLUSION: The current findings show that it is possible to counteract an age-related decline in well-being, even with only slight to moderate levels of frailty. PRACTICE IMPLICATIONS: Cheap and easily accessible interventions, like the self-management bibliotherapy described in this article, may provide a useful addition to more traditional gerontological interventions.

Activities of Daily Living↗
PubMed2005

How to measure self-management abilities in older people by self-report. The development of the SMAS-30.

This paper presents the results of two studies carried out in order to design and test a self-report instrument to measure Self-Management Ability (the SMAS-30) in aging individuals. SMA refers to the core behavioral and cognitive abilities which presumably contribute to sustainable well-being in later life. Robust findings of the studies (n = 275 and n = 1338) showed that SMA could be measured reliably as a composite concept of abilities systematically linked to dimensions of well-being in adults aged 65 and over, with the different sub-scales revealing a profile of inter-related abilities. A sub-sample of participants in Study 2 (n = 86) showed that the SMAS-30 had high reproducibility over a period of 16 weeks. The validity of the SMAS-30 was supported by meaningful associations with other constructs in both studies. As expected, the older and frailer the people, and the poorer their perceived health, the lower their SMA. Moreover, SMA was positively related to several dimensions of subjective well-being and the related concepts of general self-efficacy and mastery.

Aged↗
PubMed2005

Operationalization of biopsychosocial case complexity in general health care: the INTERMED project.

OBJECTIVE: Lack of operationalization of the biopsychosocial model hinders its effective application to the increasingly prevalent problems of comorbidities in clinical presentations. Here, we describe the INTERMED, an instrument to assess biopsychosocial case complexity in general health care, and provide an overview of its psychometric evaluation. METHOD: Review and summary of our publications to date, and re-analysis of findings. RESULTS: The INTERMED has face-validity, is brief and easy to use, and several research reports support its reliability and validity. It has the capacity to detect patients at risk for poor clinical outcome and quality of life. CONCLUSIONS: The INTERMED project is relevant to various agents involved in the care process. It provides a basis for effective multidisciplinary treatment of patients with a high case complexity.

Comorbidity↗
PubMed2005

Fecal microbiota composition and frailty.

The relationship between fecal microbiota composition and frailty in the elderly was studied. Fecal samples from volunteers with high frailty scores showed a significant reduction in the number of lactobacilli (26-fold). At much higher population levels, both the Bacteroides/Prevotella (threefold) and the Faecalibacterium prausnitzii (fourfold) groups showed a significant reduction in percentage of total number of hybridizable bacteria in the elderly with high frailty scores. In contrast to this, the number of Enterobacteriaceae was significantly higher (sevenfold) in samples from very frail volunteers.

Aged↗
PubMed2004

The effect of social comparison information on the life satisfaction of frail older persons.

In this study, the authors examined the effects of social comparison on the life satisfaction of 455 community-dwelling older persons. These older persons were confronted with a fictitious interview with either an upward or a downward target. After downward comparison, older persons felt more satisfied with their lives than after upward comparison, especially those who had higher levels of frailty. These effects were only found with lower levels of identification. Apparently, downward comparison only serves its self-enhancing function on life satisfaction among frail older persons when they perceive the comparison target as different from themselves.

Aged↗
PubMed2004

Old or frail: what tells us more?

BACKGROUND: Selecting elderly persons who need geriatric interventions and making accurate treatment decisions are recurring challenges in geriatrics. Chronological age, although often used, does not seem to be the best selection criterion. Instead, the concept of frailty, which indicates several concurrent losses in resources, can be used. METHODS: The predictive values of chronological age and frailty were investigated in a large community sample of persons aged 65 years and older, randomly drawn from the register of six municipalities in the northern regions of the Netherlands (45% of the original addressees). The participants' generative capacity to sustain well-being (i.e., self-management abilities) was used as the main outcome measure. RESULTS: When using chronological age instead of frailty, both too many and too few persons were selected. Furthermore, frailty related more strongly (with beta values ranging from -.25 to -.39) to a decline in the participants' self-management abilities than did chronological age (with beta values ranging from -.06 to -.14). Chronological age added very little to the explained variances of all outcomes once frailty was included. CONCLUSIONS: Using frailty as the criterion to select older persons at risk for interventions may be better than selecting persons based only on their chronological age.

Age Factors↗
PubMed2004

The interpretation of social comparison and its relation to life satisfaction among elderly people: does frailty make a difference?

We examined the interpretation of upward and downward social comparison and its effect on life satisfaction in a questionnaire study among 444 community-dwelling elderly persons with different levels of frailty. As we expected, elderly persons with higher levels of frailty were less inclined to contrast and more inclined to identify themselves with a downward comparison target. Furthermore, they were more inclined to contrast themselves with an upward comparison target, but contrary to our expectations, they were also more inclined to identify with this target. Upward identification and downward contrast related positively, whereas upward contrast and downward identification related negatively to life satisfaction. These effects existed independently of the negative effect of frailty on life satisfaction.

Aged↗
PubMed2002

Is glycogen storage disease 1a associated with atherosclerosis?

UNLABELLED: Deficiency of microsomal glucose-6-phosphatase in liver and kidney leads to glycogen storage disease type 1a (GSD 1a). Notwithstanding intensive dietary therapy, moderate to severe dyslipidaemia and microalbuminuria, both known atherosclerotic risk factors, remain present. Although more patients reach adult age, no information is still available about accelerated atherosclerosis. The aim of our study was to investigate whether GSD 1a was associated with premature atherosclerosis. In nine adolescent patients (mean age 22.7+/-3.4 years) and nine matched healthy control subjects, lipid profile, blood pressure, ankle-brachial indices, aortic distensibility and intima-media thickness (IMT) of the carotid and femoral arteries were determined. As expected, lipid profiles were significantly unfavourable in the patient group compared with the control group. No differences were found in blood pressure, ankle-brachial indices and aortic distensibility between both groups. IMT segments were comparable in both groups, with even thinner segments in the patient group. In different multivariate models, GSD 1a remained an independent predictor for a thinner IMT (R(2)=0.90; beta=-0.69; P=0.018). CONCLUSION: glycogen storage disease type 1a is not associated with premature atherosclerosis, despite the existence of longstanding dyslipidaemia and microalbuminuria.

Adult↗
PubMedDate not supplied

Depressive symptoms in elderly patients after a somatic illness event: prevalence, persistence, and risk factors.

Elderly patients with somatic illness are at increased risk of depression. The authors studied the prevalence and persistence of depressive symptoms during the first year after the events of myocardial infarction, congestive heart failure, fall-related injury, and the diagnosis of cancer and their putative pre-event risk factors. The GLAS study contains data from 614 patients who experienced post-baseline myocardial infarction, cancer, heart failure, or fall-related injury of the extremities within 5 years after the baseline assessment. Follow-up was conducted 8 weeks, 6 months, and 1 year after the somatic event. The authors studied the relative importance of 21 baseline risk factors for experiencing significant depressive symptoms during follow-up and the persistence of depression. Depressive symptoms were prevalent in 38.3% of the subjects during the post-event year; in about 19.1%, symptoms were mild. For a majority of patients (67.5%), symptoms persisted until the next assessment. Significant pre-event risk factors were depressive symptoms at baseline, age, smoking, poor general health, poor well-being, and neuroticism. Within the depressed group, only neuroticism was related to the persistence of symptoms. Neuroticism increases the risk of experiencing post-event depressive symptoms and is related to their persistence, which suggests the existence of a depression-prone personality.

Accidental Falls↗
PubMedDate not supplied

Psychotropic drugs and the perioperative period: a proposal for a guideline in elective surgery.

Evidence-based guidelines for the perioperative management of psychotropic drugs are lacking. The level of evidence is low and is based on case reports, open trials, and non-systematic reviews. However, the interactions and effects mentioned indicate that patients who use psychotropics and require surgery have an enhanced perioperative risk. A group of clinicians from several clinical disciplines determined which risks should be considered in an integrated preoperative assessment, as well as how psychotropics might interfere with these risks. The risks that should be considered in the perioperative period are the extent of the surgery, the patient's physical state, anesthesia, the direct and indirect (Phase I and II) effects of psychotropics, risk of withdrawal symptoms, and risk of psychiatric recurrence or relapse. Because of new drug developments, the risk of interactions increases. The literature has not provided articles that systematically address these risks. On the basis of a systematic analysis of the available literature guided by the formulated perioperative risks, a proposal for the perioperative management of psychotropics was formulated. Patients who use lithium, monoamine oxidase inhibitors, tricyclics, and clozepine have serious drug-drug interactions, with increased physical risks, including withdrawal, and therefore qualify for American Society of Anesthesiologists (ASA) Classification 3. From the perspective of the physical risk, they require discontinuation. However, from the perspective of the risk of withdrawal and psychiatric relapse and recurrence, these patients deserve intensive, integrated anesthetic/psychiatric management. For patients on selective serotonin reuptake inhibitors (SSRIs) who are mentally and physical stable (ASA Classification 2), the risk of withdrawal seems to justify their continuation. Yet, patients on SSRIs with higher physical or psychiatric risks should be seen in consultation. Both the physical and psychiatric risks of patients who use antipsychotics and other antidepressants should be regarded as enhanced. From a physical perspective, they qualify for ASA Classification 2. From the perspective of withdrawal and psychiatric recurrence or relapse, they should be seen by (their) psychiatrists. Preoperative assessment clinics offer the opportunity to assess and evaluate these risks in order to deliver patient-tailored integrated care. Authors propose a model for quality management.

Anesthesia↗
PubMedDate not supplied

Depressive symptoms in elderly patients predict poor adjustment after somatic events.

OBJECTIVE: The authors tested the hypothesis that elderly subjects with premorbid depressive symptoms are at increased risk of poor adjustment after a somatic event. METHODS: The GLAS study contains a baseline assessment and a follow-up of subjects who experienced post-baseline acute myocardial infarction, cancer, congestive heart failure, or fall-related injury of the extremities within 5 years after baseline assessment. Follow-up was conducted at 8 weeks, 6 months, and 1 year after the somatic event. Of a baseline sample of 5,279 elderly subjects (57 and older), 1,124 subjects who experienced one of the specified events were contacted, and sufficient follow-up data were obtained from 558 subjects. Authors analyzed the course of self-reported physical, role, and social functioning, and general health and well-being in subjects without baseline limitations. Patients with poor adjustment after the event were compared with patients with good adjustment on baseline depressive symptoms. They used logistic-regression analysis, controlling for several confounders. RESULTS: In multivariate analyses, pre-event depressive symptoms were associated with an increased risk of poor adjustment in terms of social and role functioning, well-being, and general health, but not physical functioning. CONCLUSIONS: Elderly persons living in the community reporting depressive symptoms are at increased risk of poor psychosocial adjustment after a somatic event. Each reported baseline depressive symptom was associated with an increased risk of chronic decline; this finding stresses the importance of detecting and treating depression in community-living elderly persons.

Adjustment Disorders↗