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Biomedical subjects

P Höppener

Publications and source records attributed to P Höppener.

13 recordsLinked to original sources
PubMed1996

Development of ST-segment elevation and Q- and R- wave changes in acute myocardial infarction and the influence of thrombolytic therapy.

Sequential electrocardiograms for admission to 36 hours in 358 patient s with acute myocardial infarction (AMI) from the Pro-urokinase In Myocardial Infarction trial were assessed. The electrocardiogram was also examined at discharge in 69 of 358 patients. Patients underwent acute angiography, after which angioplasty was performed in most patients with impaired flow. The sum of the ST-segment deviation and Q- and R- wave voltages, and the QRS score were calculated and used for further evaluation. Development of Q waves, lost of R waves, and QRS score were completed within the first 9 hours after onset of AMI and remained stable thereafter. Reperfused patients had earlier stabilization and less severe electrocardiographic (ECG) abnormalities than nonreperfused patients. ST-segment elevation had already stabilized after 5 hours, was unchanged at 36 hours, and had significantly decreased at discharge. No significant ECG and clinical outcome differences were found between the Thrombolysis In Myocardial Infarction trial (TIMI) 2 and TIMI 3 patients. A 23.3% gain in ECG-estimated infarct size was found in the reperfusion group compared with a 12.0% gain in the nonreperfused group (p = 0.08). In summary, as early as 9 hours after onset of AMI, QRS changes were already complete. Thereafter, QRS morphology was stable. Thus, a QRS-based estimation of infarct size can be made as early as 9 hours after AMI. A similar ECG outcome for patients with TIMI 2 and 3 flow was found, which was significantly different from patients with TIMI 0 to 1 flow.

Aged↗
PubMed1993

Completeness of cancer registration in Limburg, The Netherlands.

The completeness of cancer registration in the IKL (Integraal Kankercentrum Limburg) cancer registry, Limburg, the Netherlands, was evaluated for the years 1988-1990 by means of the independent case ascertainment method. This study was performed in co-operation with the Registration Network of Family Practices (RNFP) of the University of Limburg. The RNFP is a centralized database used by general practitioners (GP), containing their patients' background variables and diagnoses. The contents of the two databases were compared using computerized record linkage. If the information from both databases differed, this was verified using the source forms of the cancer registry and the GP involved. By combining the information from both registries in this way it was determined which malignancies should have been registered by the cancer registry. The IKL cancer registry had recorded 307 of the 319 eligible malignancies (96.2%). Five of the 12 missed registrations could be attributed to systematic shortcomings in the notification procedures. The estimated completeness for all malignancies of the IKL cancer registry is comparable with the results from cancer registries outside the Netherlands which have been established for longer.

Adolescent↗
PubMed1992

[Digoxin therapy in 24 automated family physician practices].

Since recent insights indicate that most patients with heart failure and a normal cardiac rhythm (HFNR) should not be treated with digitalis, we investigated the treatment policy of general practitioners in this respect. Our descriptive study consisted of a questionnaire followed by a computer based review of patient records of 14 family practices cooperating in the Registration Network of Family Practice (RNFP) and 10 'external' practices. All GPs (n = 51) received the questionnaire on the prescription policy of the GP and cooperating specialists, and on their experience with adverse effects of digitalis therapy. After 2-4 months the GPs of the RNFP (n = 41) received a floppy disc with an algorithm selecting from their problem lists patients with a registered diagnosis of heart failure. The external GPs (n = 10) received an algorithm selecting patients treated with digitalis, since their problem lists were not completely up to date. In all, data of 63,500 patients were examined. On anonymised standard forms, generated by the practice computer, the GPs provided data on the exact diagnosis, medication and adverse effects. Outcome measures of the study were: prescription attitudes (questionnaire) and actual digitalis use (in the selected cases). 33% of the GPs stated that they used digitalis as the preferred therapy of heart failure with normal cardiac rhythm; 30% of the 82 selected HFNR patients had digitalis, while in 42% of the 149 selected patients treated with digitalis a HFNR was registered. Adverse effects had been observed in 3 cases, but could not be excluded retrospectively in 70 cases (49%). Many GPs have not yet adapted their prescription behaviour to recently published insights. Development of a 'digitalis standard in general practice' is recommended.

Clinical Protocols↗
PubMed1992

Chronic illness in the community and the concept of 'social prevalence'.

General practice is an important source of information on the occurrence and distribution of chronic disease in the population. In this study, the burden of chronic illness was expressed as different indices of prevalence. Data were provided by 42 general practitioners in 15 computerized practices, collaborating in the Registration Network Family Practices of the University of Limburg in the Netherlands. Morbidity data concerning the actual health status of 25,357 subjects, as recorded by their GPs, were classified following the International Classification of Primary Care using the diagnostic criteria of the International Classification of Health Problems in Primary Care-2-Defined. The most frequent single disease was asthma (3.5%), while locomotor problems represented the most prevalent category (8.3%). The overall prevalence of chronic disease was 29.4%, with a clear positive correlation with age and, to a lesser extent, with a lower educational level. The 'social prevalence' of chronic illness (including individuals related to chronically diseased patients via their households) could be measured in a subset of the database (n = 4577), and amounted to 56%. It is concluded that the role of the GP as a family doctor involved with chronic disease concerns the majority of the general population.

Adolescent↗
PubMed1992

Computerization of general practices and quality control. Blood glucose regulation in type 2 diabetics investigated in the Registration Network family practices.

The extent to which computerized medical administration facilitates quality control was studied using as an example the quality of blood glucose regulation in diabetics supervised by general practitioners in 11 computerized practices. Systematic use of the general practice computer rapidly provided an unequivocal answer that 37% of such patients were not regulated in accordance with the guidelines for type 2 diabetes mellitus of the Dutch College of General Practitioners. The extra workload for the participating general practitioners was minimal. Automated recording of problem lists, as applied in the general practices belonging to the Registration Network, facilitates access to data on chronic diseases and risk factors for purposes of research, quality control and quality assessment.

Blood Glucose↗
PubMed1992

Computerized health information in The Netherlands: a registration network of family practices.

A registration network of family practices (Registratienet Huisartspraktijken) has recently been established in the Netherlands. Forty two general practitioners in 15 practices, with a patient population of 80,000 people, are using a general practice health information system to establish a central computerized anonymous database containing certain patient characteristics and all relevant health problems. By September 1990 patient characteristics and problem lists for 32,972 patients had been entered and a total of 94,476 health problems had been identified. The database has been set up primarily as a sampling frame, allowing researchers to identify patients with particular health problems. The database can also provide descriptive data on prevalence and incidence rates, fulfil a monitoring function and provide data for practice audit, medical education and health management.

Adolescent↗
PubMed1991

Predictors of return to former leisure and social activities in MI patients.

Outcome after myocardial infarction (MI) is commonly conceptualized as exercise tolerance, recurrent infarction and return to work. In the present study a relative measure of return to former leisure and social activities (LSA) was tested in 366 myocardial infarction (MI) patients. Next, the hypothesis that psychosocial factors are more important predictors for return to LSA than medical ones, was tested. It appeared that at baseline (3 weeks after MI) 36%, at post-test (3 months after MI) 51% and at follow-up (1 year after MI) 54%, reached former levels of LSA. It could be shown, both in multiple regression analysis and path analysis, that psychological vulnerability at baseline is the most important predictor of return to former LSA. Females, older patients, single patients and patients with angina pectoris showed an unfavorable psychological profile at baseline. It is suggested that more attention should be given to the improvement of the psychological status soon after MI for the categories of patients mentioned.

Activities of Daily Living↗
PubMed1988

Do personal computers make doctors less personal?

Ten months after the installation of a computer in a general practice surgery a postal survey (piloted questionnaire) was sent to 390 patients. The patients' views of their relationship with their doctor after the computer was introduced were compared with their view of their relationship before the installation of the computer. More than 96% of the patients (n = 263) stated that contact with their doctor was as easy and as personal as before. Most stated that the computer did not influence the duration of the consultation. Eighty one patients (30%) stated, however, that they thought that their privacy was reduced. Unlike studies of patients' attitudes performed before any actual experience of use of a computer in general practice, this study found that patients have little difficulty in accepting the presence of a computer in the consultation room. Nevertheless, doctors should inform their patients about any connections between their computer and other, external computers to allay fears about a decrease in privacy.

Attitude to Computers↗
PubMed1987

A questionnaire to assess premonitory symptoms of myocardial infarction.

To test the hypothesis that feelings of vital exhaustion precede the onset of myocardial infarction, and to develop a short questionnaire to assess these feelings, a prospective study was done among 3877 males, aged 39-65 years. During a 4.2-year follow-up period, 59 fatal or non-fatal infarctions occurred. The mean score of future coronary causes as determined by a questionnaire assessing feelings of vital exhaustion was significantly higher than the mean score of a control group matched for age, blood pressure, cholesterol and smoking. Given the validity of the model, it was possible to reduce markedly the size of the questionnaire.

Adult↗
PubMedDate not supplied

General practice registration networks in the Netherlands: a brief report.

In the Netherlands, several general practice registrations exist. Groups of general practitioners register elements of patient care according to agreed-upon criteria, and these data are collected in a central database. By means of a questionnaire the authors interviewed the managers of all nine computerized registration networks extensively about the possibilities and limitations of their registration. In addition, respondents answered some questions with data from the central database of their network. Various items are collected by nearly all the registration networks, while other items are collected by only one network. Answering questions with data from the central database turned out to be difficult. Organization and manpower are the main obstacles.

Databases, Factual↗