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T J van der Cammen

Publications and source records attributed to T J van der Cammen.

16 recordsLinked to original sources
PubMed2004

[Delayed discharge of older patients from the Department of Geriatric Medicine of the Erasmus Medical Centre and factors affecting the length of stay; July 2001--June 2002].

OBJECTIVE: To determine how the discharge of older patients proceeds and what factors affect it. DESIGN: Descriptive. METHOD: Data were collected on the 123 patients admitted to the Department of Geriatric Medicine of the Erasmus Medical Centre in Rotterdam, the Netherlands: retrospectively, from the patient files, for the admissions in the period from 1 July 2001 to 31 March 2002, and prospectively for the admissions between 1 April and 30 June 2002. Key figures in the discharge process were also interviewed during the period from 1 September to 21 November 2002. RESULTS: The average age was 83.5 years (SD: 7); 34% were males. The average duration of treatment was 13 days while the average length of admission was 22 days. There was an average of 10 days between the request from the Geriatrics Department to discharge from the hospital, via a care office for an additional-care facility, an Aftercare Office and a Regional Indicating Office (RIO). Patient characteristics that were associated with a longer duration of admission and a longer discharge procedure were: discharge to a somatic nursing home, a diagnosis of 'delirium' or 'dementia', and living independently at home before admission. Patients who were known to the Geriatrics Department (either via the outpatient clinic or via a previous admission) had a shorter duration of admission. Of all the indication decisions of the RIO, only one deviated from the recommendation of the Geriatrics Department. CONCLUSION: The average duration of admission was 9 days longer than the average duration of treatment. The discharge procedure could be accelerated by simplifying the bureaucratic process surrounding indication and referral to an additional-care facility and by accepting the recommendations of the Geriatrics Department.

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PubMed2000

Contribution of adverse drug reactions to hospital admission of older patients.

OBJECTIVE: To describe the severity of adverse drug reactions as a factor in hospital admission of older patients, and to identify risk indicators for severe adverse drug reactions in these patients. DESIGN: Observational cross-sectional study. SETTING: Five wards in a university hospital in The Netherlands. SUBJECTS: Patients aged 70 and over admitted to general medical wards. METHODS: Use of statistical comparison and Kramer's algorithm. RESULTS: A severe adverse drug reaction was present in 25 (24%) of 106 patients. Thirteen patients (12%; 95% confidence interval 6.1-18.6%) were admitted probably because of an adverse drug reaction. Risk indicators for a severe adverse drug reaction were a fall before admission (odds ratio 51.3, P = 0.006), gastrointestinal bleeding or haematuria (odds ratio 19.8, P < 0.001) and the use of three or more drugs (odds ratio 9.8, P = 0.04). CONCLUSION: Adverse drug reactions are an important cause of hospital admissions in older people. A fall before admission may indicate a severe adverse drug reaction.

Accidental Falls↗
PubMed2000

Do older hospital patients recognize adverse drug reactions?

OBJECTIVE: To establish the relationship between subjective complaints of side effects of drugs and the objective presence of adverse drug reactions in older patients. DESIGN: Observational cross-sectional study. SETTING: Five medical wards at the University Hospital Rotterdam Dijkzigt. SUBJECTS: Patients aged 70 and over admitted to the general medical wards over a 3-month period. METHODS: Statistical comparison and Kramer's algorithm. RESULTS: Of 106 patients, 102 used medication, and 93 of these were able to report whether they believed they were experiencing drug side effects. Thirty-six [39% (95% confidence interval 28.8-48.6)] believed that they were experiencing side effects and the number of diagnoses per patient and the proportion of patients with chronic obstructive pulmonary disease was higher in these 36 'complainers' than in the group of the 'non-complainers'. We found a correct opinion (true positive and negative) about the objective presence or absence of mild or severe adverse drug reactions in 79% (95% confidence interval 70.2-86.8). Asking the patient about side effects of drugs had a sensitivity of 0.70 and a specificity of 0.85 patients. The severe adverse drug reactions in 21 patients were not recognized by 14 of them. CONCLUSION: At hospital admission, older patients should be asked about drug side effects because they are often correct in recognizing them. However, severe adverse drug reactions are not easily recognized.

Adverse Drug Reaction Reporting Systems↗
PubMed1998

Abnormal amino acid metabolism in patients with early stage Alzheimer dementia.

Plasma levels of several amino acids were studied in 14 patients with early stage probable Alzheimer's disease (AD) and 17 age-matched controls. In the AD patients a possible relationship between amino acid levels and behavioural symptomatology was also investigated. We found significantly reduced levels of tryptophan and methionine in plasma samples from the AD patients compared to the control subjects. Moreover, plasma tyrosine/large neutral amino acids (LNAA) ratio and the ratio of plasma taurine and the product of the plasma levels of methionine and serine (TSM-ratio) were significantly increased in the AD patients in comparison with the controls. However, no difference was found in plasma tryptophan/LNAA ratio and in homocysteine levels between both groups. Concerning the behavioural symptomatology no significant correlation was found between the Reisberg Behave AD scale and plasma amino acid levels or ratios. The reported findings suggest that abnormal amino acid metabolism is present in the early stages of AD. We hypothesize that this abnormality could play a role in the pathogenesis of behavioural changes occurring in later stages of AD.

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PubMed1998

Risk of left ventricular dysfunction in patients with probable Alzheimer's disease with APOE*4 allele.

OBJECTIVE: To examine the association between the APOE genotype and cardiovascular disease in Alzheimer's disease (AD) patients. DESIGN: Case register study of 100 consecutive referrals to a Memory Clinic where type of dementia and cardiovascular comorbidity were diagnosed and APOE genotype was determined. SETTING: The Memory Clinic, University Hospital Rotterdam Dijkzigt. PARTICIPANTS: One hundred Memory Clinic patients, 59 to 91 years of age, who attended the Memory Clinic in the period between January 1994 and March 1996. MEASUREMENTS: Relative risk of cardiovascular morbidity in probable AD, based on clinical and ECG findings. RESULTS: The diagnosis of probable AD was more frequent in APOE*4 allele-carrying AD patients. When comparing homozygotes for APOE*4 with homozygotes for APOE*3, a nine-fold increase in prevalence of cardiac ischemia on ECG was found in the former. When grouping parameters of left ventricular dysfunction, the prevalence was 7.2 (95% confidence interval 1.2-42.6) times greater in probable Alzheimer patients with APOE4/4. CONCLUSIONS: In patients with probable AD, APOE*4 is associated with cardiac disease indicative of left ventricular dysfunction.

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PubMed1995

Prevalence of Alzheimer's disease and vascular dementia: association with education. The Rotterdam study.

OBJECTIVE: To estimate the prevalence of dementia and its subtypes in the general population and examine the relation of the disease to education. DESIGN: Population based cross sectional study. SETTING: Ommoord, a suburb of Rotterdam. SUBJECTS: 7528 participants of the Rotterdam study aged 55-106 years. RESULTS: 474 cases of dementia were detected, giving an overall prevalence of 6.3%. Prevalence ranged from 0.4% (5/1181 subjects) at age 55-59 years to 43.2% (19/44) at 95 years and over. Alzheimer's disease was the main subdiagnosis (339 cases; 72%); it was also the main cause of the pronounced increase in dementia with age. The relative proportion of vascular dementia (76 cases; 16%), Parkinson's disease dementia (30; 6%), and other dementias (24; 5%) decreased with age. A substantially higher prevalence of dementia was found in subjects with a low level of education. The association with education was not due to confounding by cardiovascular disease. CONCLUSIONS: The prevalence of dementia increases exponentially with age. About one third of the population aged 85 and over has dementia. Three quarters of all dementia is due to Alzheimer's disease. In this study an inverse dose-response relation was found between education and dementia--in particular, Alzheimer's disease.

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PubMed1994

Assessment of cerebral perfusion with single-photon emission tomography in normal subjects and in patients with Alzheimer's disease: effects of region of interest selection.

The shape, size and location of regions of interest (ROIs) show considerable variability between single-photon emission tomography (SPET) studies in aging and Alzheimer's disease, but the possible influence on study results remains unknown. We compared three different ROIs in a SPET study with 60 controls and in 48 patients with probable Alzheimer's disease diagnosed according to the NINCDS-ADRDA criteria. Regional cerebral blood flow (rCBF) was assessed with SPET using technetium-99m d,l-hexamethylpropylene amine oxime (99mTc-HMPAO), normalized to the mean activity in a cerebellar reference slice. The three different ROIs were: a multi-slice and a single-slice ROI with reference to the normal brain anatomy (using an anatomical atlas), and a rectangular (2 x 4 pixels) ROI in the frontal, temporal, temporoparietal and occipital cortices. No differences were observed for the means of rCBF values between the single-slice and multi-slice ROI's with reference to the normal anatomy, but some variability was present for individual comparisons. In contrast, significantly higher mean rCBF values were obtained with the single-slice rectangular ROIs in all four regions for both patients and controls and considerable variability was shown for individual subjects. After analysis with multivariate logistic regression and receiver operator characteristic curves, the ability of SPET to discriminate between controls and Alzheimer patients was similar in the three methods for mild and moderate Alzheimer patients (Global Deterioration Scale = GDS of 3 and 4). However, with increasing dementia severity (GDS > 4) the rectangular ROIs showed lower ability to discriminate between groups compared to the single-slice and multi-slice anatomically defined ROIs.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1994

The diagnostic value of SPECT with Tc 99m HMPAO in Alzheimer's disease: a population-based study.

We studied the diagnostic accuracy of single-photon emission computed tomography (SPECT) with technetium 99m-labeled hexamethylpropylene amine oxime (Tc 99m HMPAO) in 48 patients with probable Alzheimer's disease (AD) according to NINCDS-ADRDA criteria and in 60 controls recruited from a population-based study. With logistic regression, we identified decreased temporal regional cerebral blood flow as the best discriminating variable between patients and controls. Receiver-operator characteristic curves showed that the discriminative ability of SPECT improved with increasing dementia severity. With specificity set at 90%, sensitivity figures were 42% in mild, 56% in moderate, and 79% in severe AD. The diagnostic gain as a function of the prior probability of the disease being present was computed for those with mild AD. When the prior probability varied at around 50%, the diagnostic gain for mild AD patients was substantial (a maximum of 34%) for a positive test result but poor for a negative test result. The results suggest that the practical usefulness of SPECT as a diagnostic adjunct in patients suspected of having mild AD is confined to situations in which, on clinical grounds, there is considerable diagnostic doubt.

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PubMed1994

Unusual consequence of a fall: pressure sores of both breasts resulting in bilateral partial mastectomy.

An elderly patient is described who developed severe pressure sores of both breasts resulting in bilateral partial mastectomy. She presented with hypothermia after lying prone on the floor for over 48 h. Additional contributing factors included medication with benzodiazepines, overweight and age. The pathophysiology of the unusual predilection area of the pressure sores is discussed.

Accidental Falls↗
PubMed1993

Trait-anxiety and achievement motivation are positively correlated with memory performance in patients who visit a geriatric outpatient clinic with amnestic symptoms.

Memory performance was studied in relation to anxiety and achievement motivation in a sample of 35 patients who were referred to a geriatric outpatient clinic for their complaints of memory dysfunction. State-anxiety appeared not to be associated with memory performance or the severity of dementia. Trait-anxiety and achievement motivation were associated positively with memory performance and negatively with the severity of dementia. The evaluation of anxiety symptoms in the assessment of dementia is recommended.

Achievement↗
PubMed1992

Value of the Mini-Mental State Examination and informants' data for the detection of dementia in geriatric outpatients.

The Dutch version of the Mini-Mental State Examination was administered to 138 elderly patients who were referred to a geriatric outpatient clinic for a variety of reasons. An optimal cut-off point of 24/25 was found for the detection of dementia. At this cut-off point, the Mini-Mental State Examination was 87.6% sensitive and 81.6% specific in detecting dementia. The discriminative validity was influenced by education and by the presence of psychiatric disorders other than dementia. Informants' data showed better sensitivity and specificity than the Mini-Mental State Examination for the detection of dementia. The findings suggest that informants' data are a primary source of information for the detection of dementia in geriatric outpatients.

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PubMed1988

[The Department of Geriatrics in The Netherlands. A comment on the advice of the National Council for Public Health and the College for Hospital Provisions concerning departments of geriatrics in general hospitals].

In September 1987 the central advisory bodies for the Dutch health care system issued their advisory report on the further development of departments of geriatric medicine in general hospitals in the Netherlands. The report is awaiting judgement by the Dutch government. The lack of training capacity seems the main problem for the future of geriatric medicine in the Netherlands. Short-term plans aim to strengthen the six existing general hospital departments of geriatric medicine, to increase their training capacity and to enhance their influence by giving them 'satellite-functions' such as satellite-out patient clinics and satellite-consultations. Long-term plans are to set up departments of geriatric medicine in university hospitals, in order to further stimulate training, teaching and research. The authors favour a faster development of university hospital departments of geriatric medicine.

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