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Biomedical subjects

W Hart

Publications and source records attributed to W Hart.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Acute cardiovascular complications of vigorous physical exertion by untrained persons].

Physical exertion has paradoxical effects: regular physical activity offers protection against cardiovascular diseases, but, on the other hand, it has been shown that strenuous exercise can provoke coronary heart disease and sudden death. The risks of vigorous exertion apply particularly to untrained individuals and persons with a sedentary lifestyle. Physical exertion can cause a myocardial infarction or sudden death in people who were considered perfectly healthy before this event. In most cases, the mechanism of this is probably a rupture at the site of a vulnerable atherosclerotic plaque, with local activation of coagulation. Disturbances in cardiac rhythm may also be a cause of these complications.

Coronary Disease↗
PubMed2002

[The new CBO-guideline 'Osteoporosis' is a broadly supported standard for clinical practice].

The Dutch Institute for Health Care Improvement (CBO) has published new (revised) guidelines for the screening and case-finding of osteoporosis and for its prevention and treatment. During the last few years, two other guidelines have been published by the Dutch College of General Practitioners and the Dutch Health Council, respectively. The CBO guideline would seem to reflect the current views on clinical practice the best and is supported by all the relevant medical specialist communities. Screening of the general population is discouraged, whilst case-finding is recommended with selected patients. Compared to the 1999 standard of the Dutch College of General Practitioners, this new consensus offers more possibilities for the preventive treatment of patients with possible osteoporosis and the treatment of patients with the disease. In the first years after menopause, treatment with oestrogens (combined if necessary with progestagens), tibolone and selective oestrogen receptor modulators may be considered. Treatment with bisphosphonates is advised in persons who are being or will be treated with corticosteroids, postmenopausal women with one or more osteoporotic fractures, or men and women with an increased risk and a T-score below -2.5. The CBO guideline constitutes the current standard for clinical practice with regard to osteoporosis. There would appear to be no need for a revision of the other guidelines.

Estrogen Replacement Therapy↗
PubMed2002

[The pretentions and achievements of cancer screening, in particular breast cancer screening].

The 'Vereniging Nederlands Tijdschrift voor Geneeskunde' (Dutch Journal of Medicine Association) recently held a conference about the doubts expressed in recent publications concerning the value of cancer screening and breast-cancer screening in particular. In this the discussion mainly focused on whether disease-specific mortality or overall mortality should be taken as an endpoint in the evaluation of the screening procedure. In a recent advisory report, the Health Council of the Netherlands stated that the present form of breast cancer screening ought to be continued in the Netherlands for the time being. However, during the conference it was emphasized that cancer screening must be viewed as a highly complex system. Therefore, it is impossible to measure the effects of screening by considering just one end-point, such as cancer-specific mortality. The opinion was also expressed that with the introduction of new forms of cancer screening (e.g. colon or prostate-cancer screening), experience should first of all be gained with the small-scale screening of persons with an elevated risk. This is a task in which the government should lead the way. Furthermore, the government will also need to regulate the enthusiasm that can be expected for various types of secondary preventative diagnostics offered on the free market, including cancer screening. Another important aspect of cancer screening is ensuring that the general public are thoroughly and carefully informed about the pros and cons of cancer screening. The public must know that although cancer screening can save lives, it also causes harm. People scarcely realise that screening may more often involve a loss of carefree years of life than a small chance of living longer.

Breast Neoplasms↗
PubMed2002

[Clinical thinking and decision making in practice. Unexplained rectal blood loss in a patient with multiple endocrine neoplasia type 1 syndrome].

A 55-year-old woman, known with multiple endocrine neoplasia (MEN) type 1, had rectal bleeding and later haematemesis but colonoscopy and gastroduodenoscopy revealed no abnormalities. Due to the normal results for serum gastrin concentration, gastroduodenoscopy and CT scanning of the pancreas, Zollinger-Ellison syndrome was considered to be less likely. Yet the diagnosis could be established on the basis of persistent symptoms and a positive somatostatin receptor scintigraphy. The patient was treated with high doses of a proton pump inhibitor and temporary tube feeding due to weight loss. Follow-up will take place at the endocrinology outpatients' department. Zollinger-Ellison syndrome is a relatively common feature of patients with MEN-1. The diagnosis and localisation of the gastrinoma can be difficult: serum gastrin concentrations can be normal and the sensitivity of CT scanning is low. The primary aim of treating gastrinoma is to control gastric acid hypersecretion by means of high doses of a proton pump inhibitor. The question as to whether surgery is indicated remains controversial.

Decision Making↗
PubMed2001

[Clinical thinking and decision making in practice. 4 times ERCP, 6 times ultrasonography of the upper abdomen and 3 CT-scans for a woman with recurrent fever and bacteremia].

A 42-year-old woman was hospitalised due to recurrent fever (40 degrees C) and bacteraemia. A physical examination revealed no abnormalities. Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca and Enterococci were found in blood cultures. Laboratory results revealed liver enzyme levels which were only slightly elevated. An X-ray investigation, ERCPs, CT scans, ultrasounds, a leucocyte scintigram and a gallium scan, all revealed no abnormalities. Due to the results from the blood cultures it was thought that the bile duct system or the digestive tract were the focus of infection. Therefore a liver biopsy was carried out for the purpose of making a diagnosis. The patient was diagnosed as having ductal plate malformation, a microscopic congenital cystic dilatation of the bile ducts. The prognosis is poor and the treatment consists of lifelong antibiotics.

Adult↗
PubMed2001

['Caring always'; physicians' expression of condolences to the relatives of patients].

According to the WHO definition, palliative care does not end with the death of the patient, but also includes supporting the family members in dealing with the loss. A recent article refers to the importance of physicians writing letters of condolences. The letter of condolences marks the end of the treatment relationship. Writing such a letter can assist the physician in distancing him/herself from the death of his/her patient, and the letter can also help the family adjust to life without the deceased patient. The letter can also remove any distrust that may exist towards the medical profession. Reasons for not writing a letter of condolences include an own feeling of failure, administrative difficulties, indifference or incapacity. Nevertheless, writing a letter of condolences is an integral part of the care provided by the physician to the patient and his/her relatives.

Attitude to Death↗
PubMed2001

[New CBO guideline 'High blood pressure'; family practitioners and specialists in consensus].

Under the auspices of the Dutch Institute for Health Care Improvement (CBO) a final revised version of guidelines for the detection, diagnosis and treatment of hypertension was agreed upon. These guidelines constitute a delicate compromise between the views of general practitioners and hypertension specialists. These guidelines have been published separately from a future standard on hypertension from the Dutch College of General Practitioners but no major discrepancies between these two documents are anticipated.

Family Practice↗
PubMed2001

[Physical diagnostics--peripheral arterial diseases].

In a patient with a high a priori risk of peripheral vascular disease, the positive predictive value of an abnormal physical diagnostic examination is high. In patients with a low prior probability of peripheral vascular disease, the physical examination makes little contribution to the diagnosis or exclusion of arterial insufficiency. For this purpose the ankle-brachial systolic pressure index is preferable. Peripheral arterial disease is unlikely when this index is normal. However, a low ankle-brachial index necessitates further investigations to determine possible arterial insufficiency in the lower extremities.

Ankle↗
PubMed2001

[Original articles in the Netherlands Tijdschrift voor Geneeskunde in the second part of the 20th century: type of research described and the number and background of authors].

OBJECTIVE: To determine the quantitative changes in methods and number of authors of original articles (OA) describing a (medical) scientific study in the Nederlands Tijdschrift voor Geneeskunde (NTvG) during 6 volumes in the second part of the 20th century. DESIGN: Retrospective bibliometric. METHOD: All OA published in 1949, 1959, 1969, 1979, 1989 and 1999 were screened on describing a (medical) scientific study, the method used, the number of authors, (medical) students or interns being part of the author list, the number of disciplines of the authors and the institutes where the authors did the study. RESULTS: The volumes mentioned contained 888 OA. The percentage of OA describing the used method increased from 47 in 1949 to 98 in 1999. In these OS 52% of the designs were retrospective. The proportion of prospective studies increased, but never met 25% of all OA. The median number of authors increased from 1 (range: 1-5) in 1949 to 5 (1-16) in 1999. The median number of disciplines of the authors increased from 1 (1-2) in 1949 to 3 (1-6) in 1999. The percentage of OA with students or interns being part of the author list varied from 1 in 1949 to 13 in 1999. In 1969-1999 most OA were received from authors from universities or academic hospitals. The percentage of OA received from authors from academic hospitals in collaboration with general hospitals increased from 0 in 1949 to 15 in 1999. Randomized clinical trials and prospective studies were mainly received from authors from universities or academic hospitals. The part of retrospective studies was largest among OA received from authors from general hospitals (58%). CONCLUSION: In the second part of the 20th century the OA published in the NTvG changed. The number of authors increased. In recent years most authors were from universities or academic hospitals, although the proportion written by authors from these institutes in collaboration with those from general hospitals increased. Most OA described retrospective studies, the proportion received from authors from general hospitals being the largest. The percentage of OA describing prospective studies increased over the years.

Authorship↗
PubMed2001

The relevance of stereopsis for motorists: a pilot study.

PURPOSE: To study the influence of stereoscopic depth perception on automobile driving performance. METHODS: Ten patients with strabismus and defective stereopsis were compared with ten healthy controls with respect to their performance in a series of automobile driving manoeuvres. The two groups were individually matched as to age, annual miles driven, years of licence holding and type of vehicle owned. After an ophthalmologic examination the subjects in each group performed the following series of driving tests: (1) stopping in front of an obstacle, (2) reversing into a parking space, (3) driving through a slalom course, (4) estimating the relative positions of two cars. All tests were performed binocularly and monocularly (with the non-dominant eye covered). RESULTS: Only in the slalom test did the normal subjects perform significantly better than the stereo-deficient subjects (odds ratio 10.5; P<0.01). In estimating position, normal subjects actually performed significantly worse (odds ratio 0.091; P<0.01). A significant distance ratio of 2.5 (95% CI 1.1-5.5; P=0.033) of the monocular with respect to the binocular performance of the normal subjects was found for the stopping task only, while the subjects with defective stereopsis showed no difference between their monocular and binocular performance. CONCLUSION: In this study, stereopsis had a positive effect on driving performance only in dynamic situations at intermediate distances.

Adult↗
PubMed2001

Reaction time in automated kinetic perimetry: effects of stimulus luminance, eccentricity, and movement direction.

PURPOSE: To determine the effects of stimulus eccentricity and luminance level on the reaction time (RT) of young normal volunteers during automated kinetic campimetry. METHODS: We used a specially designed video-campimetric device equipped with a continuous infrared (IR) pupillographic fixation control (Tübingen Computer Campimeter) and recorded reaction times upon presenting horizontally moving small circular stimuli (size 26'; constant angular velocity 2 degrees /s) starting at 16 locations within the central 30 degrees -radius of the visual field. Two different levels of stimulus luminance were used (41.6 cd/m(2) and 110 cd/m(2)), while background luminance was 10 cd/m(2). Each stimulus was presented a total of six times in a randomized order. Subjects were 12 healthy young individuals (aged 21-30 years) with normal ophthalmic examinations. An analysis of variance (ANOVA) was performed on the data. RESULTS: RTs showed considerable inter- and intra-individual variation with individual least squares means (LSM, fitted values of a linear model) ranging from 305 to 454 ms, and residual standard deviation (R.S.D.) 66 ms. Reaction times did not differ significantly as a function of stimulus direction (P>0.6). Higher luminance levels produced significantly reduced reaction times for all stimulus locations and directions (mean reduction: 16 ms; P<0.0001). Reaction times increased with increasing eccentricity, in the mean by 1.8 ms per degree of visual angle, from 365+/-4 ms (S.E.M.) foveally, to 407+/-2 ms at 30 degrees eccentricity; (P<0.0001). CONCLUSIONS: Automated kinetic perimetry should be designed to cope with significant, variable interindividual response characteristics. Other stimulus related factors, such as eccentricity or luminance level, have a significant but comparatively small effect on reaction time within the central 30 degrees -radius visual field in healthy young individuals.

Adult↗
PubMed2000

[Bizarre advertisements by hospitals in the Dutch Journal of Medicine].

The advertisements in this journal show that hospitals in the Netherlands are using increasingly bizarre texts to recruit physicians. Not only do they unflinchingly exaggerate phrases to describe their achievements--'top-clinical care', 'customer-orientation', 'quality improvement'--but they even emphasize their attractive surroundings and the fervor of their policy. One wonders whose interests are being served by these inflated advertisements. They are, however, clearly at odds with the advertising restrictions imposed upon individual physicians.

Advertising↗