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Biomedical subjects

R A De Melker

Publications and source records attributed to R A De Melker.

7 recordsLinked to original sources
PubMed1999

Tympanometry by general practitioners: reliable?

BACKGROUND: The diagnosis of otitis media with effusion (OME) is difficult using only medical history and otoscopy. Tympanometry may, therefore, be helpful in the diagnosis and follow-up of OME in general practice. Studies regarding the reliability of tympanogram production and validation of tympanogram outcome have been performed. OBJECTIVE: To gain insight into the usability of microtympanometry and the degree of agreement and accuracy of tympanogram classification in general practice. METHODS: Data were collected in the offices of 49 general practitioners (GP's). The usability of the microtymp was monitored against a checklist. GP's (39) classified 47 tympanograms according to Jerger's modified classification, designating them as 'OME', 'no OME' or 'interpretion impossible'. The gold standard was the consensus over the 47 tympanograms reached by three doctors very experienced in tympanometry. RESULTS: Of the general practitioners, 61% handled the microtymp faultlessly. The overall inter-observer agreement was moderate to substantial; with respect to the gold standard 74% of the general practitioners had a satisfactory to almost perfect agreement. These results were achieved after instruction and training; longer practice produced no significant improvement in the agreement. CONCLUSION: After training and instruction microtympanometry is a reliable diagnostic instrument in general practice. The classification of tympanograms is satisfactory. Classification problems arise when the curve is not a good one. Additional criteria for the assessment of the curves are proposed.

Acoustic Impedance Tests↗
PubMed1996

Do patients with sore throat benefit from penicillin? A randomized double-blind placebo-controlled clinical trial with penicillin V in general practice.

BACKGROUND: The effect of antibiotic therapy in sore throat is questionable and this dilemma has been complicated by the emergence of multiple resistant strains of micro-organisms. AIM: A randomized double-blind placebo-controlled clinical trial was undertaken in patients aged 4-60 years to assess the efficacy of penicillin V on the clinical course and bacteriological response in patients with sore throat in general practice. METHOD: Two hundred and thirty-nine patients presenting with an acute sore throat to 37 general practices in the Netherlands who were clinically suspected of group A beta-haemolytic streptococci (GABHS) were randomized for treatment with penicillin V (n = 121) or placebo (n = 118). Resolution of sore throat, fever and return to daily activities were evaluated by the general practitioner 2 days after the start of treatment and by the patients keeping a diary for 7 days. The result of throat culture after 2 days was evaluated. RESULTS: A difference in resolution of sore throat was present after 2 days in all patients, but was a result of GABHS-positive patients (n = 111; 46%) in favour of those randomized for penicillin V (adjusted odds ratio 5.3; 95% CI 1.9-15.1). An effect in the course of fever was also seen in GABHS-positive patients (adjusted odds ratio 5.3; 95% CI 1.02-27.7). A difference of 1-2 days was seen in clinical recovery. No difference was found in daily activities between the treatment groups. After 2 days, 4% of the penicillin-treated patients harboured GABHS compared with 75% of the placebo group. CONCLUSION: Only GABHS-positive patients benefit from penicillin V in their clinical cure in the first few days. Therefore, rapid testing is necessary. Treatment may be beneficial with regard to the clinical course, but it is not necessary.

Adolescent↗
PubMed1994

Simulated patients in assessing consultation skills of trainees in general practice vocational training: a validity study.

Although simulated patients are increasingly used in medical education, little research has been carried out on their validity. Validity in this case defines the relationship between performance with a simulated patient and performance with a real patient. One of the objectives of this study was to determine the validity of the use of simulated patients in assessing the consultation skills of trainees in vocational training at the Department of General Practice, University of Utrecht, The Netherlands. A check-list with a rating scale was used to assess the consultation skills of trainees at the department with simulated patients as well as in their training practices with real patients. The simulated and the selected practice cases were patients with complex multi-conditional problems like low back pain, headache and chest pain. The consultation skills were subdivided into four groups: the patient-centered approach, the non-somatic approach, communication skills and interpersonal skills. The measurement of skills, in particular of consultation skills, is very difficult. A description is given of the way the research group solved this problem. The analysis was performed by determining the sensitivity and predictive value of the assessment of a simulated encounter with a routine practice encounter. A difference existed in the assessed level of consultation skills in the simulated encounter compared to the level in the training practice. In simulation the level of consultation skills was higher than in day-to-day practice. This difference can reflect the difference between competence and performance. Competence is defined as what a doctor is capable of doing and performance as what a doctor actually does in day-to-day practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Competence↗
PubMed1992

A review of clinical trials regarding treatment of acute otitis media.

A survey was made of the English language literature on clinical trials of therapy in acute otitis media. The articles were analysed systematically for 24 parameters related to study design. We retrieved 50 studies published between 1965 and 1989. Surprisingly, the combination of a double-blind method, clearly defined inclusion criteria, and criteria for outcome was found in only 13 studies. Most of these 13 compared different antibiotic regimens and only 4 were placebo-controlled. A recommendation based on the conclusions reached can, even in these 13 studies, hardly be obtained due to failure to show an overall difference in favour of a specific treatment regimen. Our study shows that many trials are methodologically flawed which makes it difficult to accept their results. In view of current controversy on management of acute otitis media, well conducted placebo-controlled clinical trials are still needed.

Acute Disease↗
PubMed1990

Referrals to specialists. An exploratory investigation of referrals by 13 General Practitioners to medical and surgical departments.

Several aspects of referrals to medicine and surgery of National Health Service (NHS) patients in thirteen Dutch General Practices were investigated. In The Netherlands active and passive referrals have to be separated. Only one out of three referrals to medicine was an active referral on the initiative of the GP. With regard to surgical referrals about half were active referrals. About half the passive referrals were referrals in retrospect. The thirteen GPs differed in the percentages of active and passive referrals. There was a strong positive correlation between the percentages of passive referrals to medicine and surgery (Spearman Rs = .81). The correlation between the percentages of repeat cards for both groups of specialists was almost as strong (Spearman Rs = .73). In four out of five active referrals the GPs informed the specialist about some aspects of the referral, usually by letter and rarely by telephone. GPs who sent information along with a referral to medicine often did the same with a referral to surgery (Rs = .60). The legibility of the written information was, in general, moderate to poor. Only occasionally the GPs formulated clearly what they expected from the specialist. Suggestions are formulated to improve the referral process between primary and secondary care.

Adult↗
PubMed1988

Epidemiology of otitis media and the role of the general practitioner in management.

Acute otitis media and otitis media with effusion are common diseases of children. Though related to each other, they are clinically separate entities. In order to assess the effectiveness of medical interventions it is important to know the epidemiology of the condition. This paper reviews the incidence, natural history and risk factors for otitis media. In most cases acute otitis media and otitis media with effusion are self-limiting disorders. Complications and an abnormal course are rare. There are, however, subgroups of otitis-prone children, identifiable on the basis of risk factors. These children need special attention from the general practitioner, for example a more frequent use of medical interventions and surveillance. It is important to realize that individual and family factors have more influence on the outcome of otitis media than do the various available medical interventions.

Adolescent↗