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Biomedical subjects

Siep Thomas

Publications and source records attributed to Siep Thomas.

At least 19 recordsLinked to original sources
PubMed2006

Patient's quality of life and coping style influence general practitioner's management in men with lower urinary tract symptoms: the Krimpen Study.

PURPOSE: To identify patient characteristics associated with general practitioner's (GP) initial treatment decision in men with lower urinary tract symptoms (LUTS) and to test the hypothesis that a different coping style of patients results in different GP behaviour regarding treatment. MATERIALS AND METHODS: A longitudinal, population-based study with a follow-up period of 6.5 years was conducted among 1688 men aged 50-78 years old. Data were collected on quality of life, symptom severity based on the International prostate symptom score (IPSS) and coping. Information on primary care seeking and GP's initial management during 2 years of follow-up of all participants was collected from the general practitioners record. RESULTS: Data were obtained of 68 men, without a history of LUTS, who had a first GP visit for LUTS during the study period. In 54.4% of the cases the GP prescribed medication, independent of symptom severity. In the group of men with a bad disease-specific QOL those with a high passive-reaction-pattern were treated less frequently than those with a low passive-reaction-pattern. CONCLUSION: Findings from this quantitative study are consistent with the hypothesis that different coping styles of patients may result in different GP behaviour regarding treatment. The use of the coping style passive-reaction-pattern has a large influence on GP's initial management in men with LUTS.

Adaptation, Psychological↗
PubMed2006

Diagnosis of lumbar spinal stenosis: a systematic review of the accuracy of diagnostic tests.

STUDY DESIGN: Systematic review of diagnostic studies. OBJECTIVE: To investigate the diagnostic performance of tests used to detect lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: Little is known about the diagnostic accuracy of tests in detecting lumbar spinal stenosis. A systematic review will provide more insight in this topic. METHODS: We performed a literature search in Medline (PubMed) and Embase for original diagnostic studies on lumbar spinal stenosis, in which one or more different tests were evaluated with a reference standard, and diagnostic values were reported or could be calculated. Two reviewers independently checked all abstracts and full text articles for inclusion criteria. Included articles were assessed for their quality using the Quadas tool. Study features and diagnostic values were extracted from the included studies. RESULTS: Of the 24 articles included in this review, 15 concerned imaging tests, 7 evaluated "clinical tests," and 2 reported on other diagnostic tests. The overall quality was poor; only 5 studies scored positive on more than 50% of the quality items. Estimates of the diagnostic value of the tests differed considerably. The imaging studies showed no superior accuracy for myelography compared with CT or MRI. Overall, there is considerable variation in the clinical tests; some studies show high sensitivity, whereas others show high specificity. CONCLUSIONS: Because of heterogeneity and overall poor quality, no firm conclusions about the diagnostic performance of the different tests can be drawn. Better-designed studies exploring the accuracy of diagnostic tests are needed to improve the diagnostic policy.

Diagnostic Tests, Routine↗
PubMed2006

Determinants of seeking of primary care for lower urinary tract symptoms: the Krimpen study in community-dwelling men.

OBJECTIVES: To determine which factors predict seeking of primary care among men with lower urinary tract symptoms (LUTS). METHODS: A longitudinal, population-based study with a follow-up period of 6.5 yr was conducted among 1688 men aged 50-78 yr. The following data were collected: prostate volume (using transrectal ultrasonometry), urinary flow rate, ultrasound-estimated postvoid residual urine volume, generic and disease-specific quality of life (QOL), and symptom severity (International Prostate Symptom Score [IPSS]). Information on the seeking of primary care by all participants during 2 yr of follow-up was collected from the general practitioner's (GP) record using a computerised search engine and a manual check of electronically selected files. RESULTS: Prostate volume, postvoid residual volume, IPSS, and social generic QOL are important determinants of first GP consultation in men with LUTS. Measurements (physical urologic parameters) and self-reported items (symptom severity and QOL) contribute almost equally to GP consultation in these men. CONCLUSIONS: Both measurements of prostate volume and postvoid residual urine volume and self-reported information about symptoms or QOL can help to select those who will benefit from medical care and to reassure those men not likely to need help in the near future.

Aged↗
PubMed2006

Simple case definition of clinical benign prostatic hyperplasia, based on International Prostate Symptom Score, predicts general practitioner consultation rates.

OBJECTIVES: To determine which case-definition of clinical benign prostatic hyperplasia (BPH) has the best predictive value for general practitioner visits for lower urinary tract symptoms (LUTS) suggestive of BPH. The incidence and prevalence rates of general practitioner visits for LUTS were also determined. METHODS: A longitudinal, population-based study from 1995 to 2003 was conducted among 1688 men aged 50 to 78 years old. Data were collected on physical urologic parameters, quality of life, and symptom severity as determined from the International Prostate Symptom Score. Information on health-care-seeking behavior of all participants was collected from the general practitioner (GP) record using a computerized search engine and an additional manual check of the electronically selected files. RESULTS: The incidence and prevalence rate of the men at risk was 19.6% and 14.0%, respectively, and these rates increased with age. For sensitivity and the positive predictive value, the case-definition of clinical BPH as an International Prostate Symptom Score greater than 7 had the best predictive value for GP visits for LUTS within 2 years after baseline. CONCLUSIONS: Because only marginal improvement (greater specificity but lower sensitivity) in the prediction of GP visits for LUTS was possible by adding information on prostate volume and flow, for the prediction of future GP visits for LUTS suggestive of BPH, we suggest that the International Prostate Symptom Score questionnaire be used and that estimation of the prostate volume and flow is not required.

Aged↗
PubMed2005

Diabetes education on Turkish immigrant diabetics: predictors of compliance.

A controlled experiment on the effect of ethnic specific diabetes education in Turkish type 2 diabetics revealed substantial problems with compliance. The cost effectiveness of such a programme would improve if patients most likely to dropout or overuse the education facility could be identified. The 45 patients of the intervention group were categorized into three groups: non-compliers, compliers and over-compliers, and we assessed the association between patient characteristics and these three groups. Compared to the compliers, non-compliers had a longer history of diabetes and poorer knowledge of diabetes. Over-compliers were more often younger, female, scored low on attitude or self-efficacy, and experienced more stress. Turkish patients having diabetes for a longer period or with poor knowledge of diabetes are at risk to dropout from the programme, while younger Turkish females scoring low on attitude or self-efficacy as well as those with more stress, are more likely to over-use the education facility.

Adult↗
PubMed2005

Effectiveness of exercise therapy: a best-evidence summary of systematic reviews.

The purpose of this project was to summarise the available evidence on the effectiveness of exercise therapy for patients with disorders of the musculoskeletal, nervous, respiratory, and cardiovascular systems. Systematic reviews were identified by means of a comprehensive search strategy in 11 bibliographic databases (08/2002), in combination with reference tracking. Reviews that included (i) at least one randomised controlled trial investigating the effectiveness of exercise therapy, (ii) clinically relevant outcome measures, and (iii) full text written in English, German or Dutch, were selected by two reviewers. Thirteen independent and blinded reviewers participated in the selection, quality assessment and data-extraction of the systematic reviews. Conclusions about the effectiveness of exercise therapy were based on the results presented in reasonable or good quality systematic reviews (quality score > or = 60 out of 100 points). A total of 104 systematic reviews were selected, 45 of which were of reasonable or good quality. Exercise therapy is effective for patients with knee osteoarthritis, sub-acute (6 to 12 weeks) and chronic (> or = 12 weeks) low back pain, cystic fibrosis, chronic obstructive pulmonary disease, and intermittent claudication. Furthermore, there are indications that exercise therapy is effective for patients with ankylosing spondylitis, hip osteoarthritis, Parkinson's disease, and for patients who have suffered a stroke. There is insufficient evidence to support or refute the effectiveness of exercise therapy for patients with neck pain, shoulder pain, repetitive strain injury, rheumatoid arthritis, asthma, and bronchiectasis. Exercise therapy is not effective for patients with acute low back pain. It is concluded that exercise therapy is effective for a wide range of chronic disorders.

Chronic Disease↗
PubMed2005

Is influenza vaccination in asthma helpful?

PURPOSE OF REVIEW: Influenza infections are frequently involved in asthma exacerbations. During influenza epidemics substantial excess morbidity due to respiratory tract complications is reported in all age categories as well as excess mortality among the elderly. Vaccines are available for protection against influenza. Worldwide, vaccination is advised and considered a quality point for asthma care. However, the protective effect of influenza vaccination in patients with asthma is still disputed. In order to establish the current state of affairs we reviewed the recent literature on the protective effect of influenza vaccination and its usefulness in patients with asthma. RECENT FINDINGS: Several studies were found addressing influenza and the protective aspects of vaccination. They discussed the incidence, the adverse effects of vaccination, the coverage of influenza vaccination among patients with asthma and the effectiveness of the vaccine. SUMMARY: Influenza vaccination can safely be used in patients with asthma. Allegations that vaccination could provoke asthma exacerbations are convincingly invalidated by previous and recent research. Although patients with asthma are one of the major target groups for immunization, vaccine coverage in all age categories remains low. So far, no unequivocal beneficial effect of influenza vaccination in patients with asthma was found in observational and experimental studies in the sense of reduction of asthma exacerbations and other complications. Recent studies confirm these negative findings. More long-term randomized, placebo-controlled studies, focusing on influenza- proven illness in patients with asthma, are needed to address the question of how helpful influenza vaccination is in these patients.

Asthma↗
PubMed2005

The effect of educational intervention on intercultural communication: results of a randomised controlled trial.

BACKGROUND: Due to worldwide migration to Western countries, physicians are increasingly encountering patients with different ethnic backgrounds. Communication problems can arise as a result of differences in cultural backgrounds and poor language proficiency. AIMS: To assess the effectiveness of an educational intervention on intercultural communication aimed to decrease inequalities in care provided between Western and non-Western patients. DESIGN OF STUDY: A randomised controlled trial with randomisation at the GP level and outcome measurements at the patient level. SETTING: General practice in Rotterdam. METHOD: Thirty-eight Dutch GPs in the Rotterdam region, with at least 25% of inhabitants of non-Western origin, and 2407 visiting patients were invited to participate in the study. A total of 986 consultations were finally included. The GPs were educated about cultural differences and trained in intercultural communication. Patients received a videotaped instruction focusing on how to communicate with their GP in a direct way. The primary outcome measure was mutual understanding and the secondary outcomes were patient's satisfaction and perceived quality of care. The intervention effect was assessed for all patients together, for the 'Western' and 'non-Western' patients, and for patients with different cultural backgrounds separately. RESULTS: An intervention effect was seen 6 months after the intervention, as improvement in mutual understanding (and some improvement in perceived quality of care) in consultations with 'non-Western' patients. CONCLUSIONS: A double intervention on intercultural communication given to both physician and patient decreases the gap in quality of care between 'Western' and 'non-Western' patients.

Adolescent↗
PubMed2004

Does influenza vaccination exacerbate asthma in children?

BACKGROUND: The risks of influenza vaccination in asthmatic children are still being discussed. Especially, the risk that influenza vaccination may exacerbate asthma is an issue in this debate. METHODS: We conducted a randomised double-blind placebo-controlled trial in 696 children 6-18 years of age with asthma recruited in general practice during two influenza seasons, 1999-2000 and 2000-2001. Children participated for only one season. During the first week after vaccination, participants recorded local, influenza like and asthma symptoms as well as use of medication, health care use and absenteeism. RESULTS: Except for cough during the day in the first season, favouring placebo, there were no differences indicating that vaccination exacerbates asthma. CONCLUSIONS: Influenza vaccination does not seem to exacerbate asthma.

Adolescent↗
PubMed2004

Cardiovascular risk factors in Turkish immigrants with type 2 diabetes mellitus: comparison with Dutch patients.

BACKGROUND: Based on recent epidemiological studies the need for a similar approach towards management of cardiovascular risk factors in type 2 diabetics with different ethnic background can be questioned. We compared the prevalence of cardiovascular risk factors and 10-year absolute risk for a coronary heart disease between Turkish and Dutch type 2 diabetes patients. METHODS: A cross-sectional study was performed using databases from three Dutch studies on type 2 diabetes, comparing 147 Turkish to 294 Dutch diabetes patients, matched for age and gender. Main outcome measures were: total (t-) cholesterol, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglyceride, blood pressure, and smoking. The 10-year absolute risk for a coronary event was calculated by means of the Framingham risk equation. RESULTS: In Turkish diabetics t-cholesterol was lower than in Dutch (5.4 vs. 5.9 mmol/l; p < 0.001), in Turkish males HDL was lower than in Dutch male patients (0.94 vs. 1.08 mmol/l; p = 0.04). The total/HDL-cholesterol ratio in Turkish and Dutch diabetics was equal (5.4 vs. 5.4). Less Turkish than Dutch females smoked (9% vs. 23%; p<0.01). The 10-year absolute risk for a coronary event in both Turkish and Dutch male patients was 24%; the risk in Turkish vs. Dutch females was 13% vs. 15% (not significant). CONCLUSION: The absolute risk for a coronary event in Turkish type 2 diabetes patients is similar to the risk in Dutch diabetes patients, although important differences in the risk profile exist, in particular, the lipid profile and smoking habits differ.

Cholesterol, HDL↗
PubMed2004

Feasibility of diabetes peer education for Turkish type 2 diabetes patients in Dutch general practice.

The feasibility of a 9-month educational diabetes programme (tailored to Turkish patients, provided by Turkish bicultural female educators) was assessed in terms of dropout rate, patient and GP satisfaction, and GP's perceived workload. Of the 54 Turkish patients (39% males) that signed informed consent, 45 actually started the education. Dropout rate during the programme was 41% (main reason: going abroad for a long period (18%)). The individual education sessions and the consultations with the GP were highly appreciated by 87% of the patients and the group sessions by 66%. Although all nine interviewed GPs experienced a higher workload, overall appreciation of the programme was high in six GPs. Although implementation of an ethic-specific diabetes programme in general practice is well appreciated by both patients and GPs, the high dropout rate indicates that the programme needs to be more finely tuned to the individual patient.

Attitude of Health Personnel↗
PubMed2003

Influenza vaccination in children with asthma: randomized double-blind placebo-controlled trial.

There is little evidence that influenza vaccination reduces asthma exacerbations. We determined whether influenza vaccination is more effective than placebo in 6-18-year-old children with asthma. We performed a randomized, double-blind, placebo-controlled trial. Parenteral vaccination with inactivated influenza vaccine or placebo took place approximately November 1, and children were followed until April 1 of the next year. Airway symptoms were reported in a diary. When symptom scores reached a predefined level, a pharyngeal swab was taken. Primary outcome was the number of asthma exacerbations associated with virologically proven influenza infection. Three hundred forty-nine children were assigned placebo, and 347 were assigned vaccine. Pharyngeal swabs positive for influenza were related to 42 asthma exacerbations, 24 in the vaccine group and 18 in the placebo group, a difference of 33% favoring placebo (31% after adjustment for confounders; 95% confidence interval, -34% to 161%). Influenza-related asthma exacerbations were of similar severity in both groups; they lasted 3.1 days shorter in the vaccine group (95% confidence interval, -6.2 to 0.002 days, p = 0.06). We conclude that influenza vaccination did not result in a significant reduction of the number, severity, or duration of asthma exacerbations caused by influenza. Additional studies are warranted to justify routine influenza vaccination of children with asthma.

Adolescent↗