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Baghus A, Giroldi E, van Geel J, Leferink A, van de Pol MHJ, Sanders A, Dielissen PW, Bisschop I, Pieterse AH, Muris JWM, Timmerman AA, van der Weijden T. Shared decision-making performance of general practice residents: an observational study combining observer, resident, and patient perspectives. Fam Pract 2024; 41:50-59. [PMID: 38206317 PMCID: PMC10901472 DOI: 10.1093/fampra/cmad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Shared decision making (SDM) is considered fundamental to person-centred care. However, applying SDM may be a challenge for residents in general practice, since it is a complex competence that requires the integration of knowledge and skills from several competency domains. OBJECTIVE To support learning of SDM during medical residency, we aimed to gain insight in Dutch residents' observed and perceived SDM performance in general practice. METHODS We evaluated residents' SDM performance from an observer, resident, and patient perspective. Consultations of first- and third-year residents were recorded. Trained observers used the validated Observing Patient Involvement (OPTION5) scale to assess observed SDM performance of residents in 98 actual recorded consultations. Perceived SDM performance was evaluated by residents and patients completing validated SDM questionnaires, supplemented with questions about (the context of) the consultation and perceived relevance of SDM immediately after the consultation. The data were analysed using descriptive statistics (mean, SD, minimums, and maximums) and explorative bivariate analyses. RESULTS The residents' observed mean SDM performance was 19.1 (range, 0-100, SD = 10.9), mean resident self-reported SDM performance was 56.9 (range, 0-100, SD = 18.5), and mean patient-reported SDM performance was 73.3 (range, 0-100, SD = 26.8). We found a significant and positive correlation between observed SDM performance and residents' perceived relevance of SDM for the consultation (t = 4.571, P ≤ 0.001) and the duration of the consultation (r = 0.390, P ≤ 0.001). CONCLUSIONS This study showed that there is room for increasing awareness of the potential incongruence between observed and perceived SDM performance during medical residency, in order to facilitate the implementation of SDM in clinical practice.
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Affiliation(s)
- Anouk Baghus
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Esther Giroldi
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Professional Education, Maastricht University, Maastricht, The Netherlands
| | - Jasper van Geel
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Arthur Leferink
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Marjolein H J van de Pol
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ariëtte Sanders
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Patrick W Dielissen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Isabella Bisschop
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean W M Muris
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Angelique A Timmerman
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Du J, Burger H, Kupers T, Sulim K, Homburg MT, Muris JWM, Olde Hartman TC, Zuidema SU, Peters LL, Janus SIM. Patterns of psychotropic drug prescriptions and general practice consultations among community-dwelling older people with dementia during the first two years of the COVID-19 pandemic. BMC Geriatr 2024; 24:120. [PMID: 38297202 PMCID: PMC10832125 DOI: 10.1186/s12877-024-04708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic and subsequent lockdown measures had serious implications for community-dwelling older people with dementia. While the short-term impacts of the pandemic on this population have been well studied, there is limited research on its long-term impacts. Quantifying the long-term impacts may provide insights into whether healthcare adaptations are needed after the acute phase of the pandemic to balance infection prevention measures with healthcare provision. This study aims to examine patterns of psychotropic drug prescriptions and general practice consultations in community-dwelling older people with dementia during the first two years of the pandemic. METHODS We utilised routine electronic health records from three Dutch academic general practice research networks located in the North, East, and South, between 2019 and 2021. We (1) compared the weekly prescription rates of five groups of psychotropic drugs and two groups of tracer drugs, and weekly general practice consultation rates per 1000 participants, between the first two years of the pandemic and the pre-pandemic phase, (2) calculated changes in these rates during three lockdowns and two relaxation phases relative to the corresponding weeks in 2019, and (3) employed interrupted time series analyses for the prescription rates. Analyses were performed for each region separately. RESULTS The study population sizes in the North, East, and South between 2019 and 2021 were 1726 to 1916, 93 to 117, and 904 to 960, respectively. Data from the East was excluded from the statistical analyses due to the limited sample size. During the first two years of the pandemic, the prescription rates of psychotropic drugs were either lower or similar to those in the pre-pandemic phase, with differences varying from -2.6‰ to -10.2‰. In contrast, consultation rates during the pandemic were higher than in the pre-pandemic phase, increasing by around 38‰. CONCLUSIONS This study demonstrates a decrease in psychotropic drug prescriptions, but an increase in general practice consultations among community-dwelling older people with dementia during the first two years of the pandemic. However, reasons for the decrease in psychotropic drug prescriptions are unclear due to limited information on the presence of neuropsychiatric symptoms and the appropriateness of prescribing.
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Affiliation(s)
- Jiamin Du
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Huibert Burger
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Thijmen Kupers
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Karina Sulim
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Maarten T Homburg
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Jean W M Muris
- Department of Family Medicine, Maastricht University Medical Centre, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Sytse U Zuidema
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Alzheimer Centre Groningen, Groningen, the Netherlands
| | - Lilian L Peters
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Sarah I M Janus
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
- Alzheimer Centre Groningen, Groningen, the Netherlands.
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Voorhaar M, van Schayck OCP, Winkens B, Muris JWM, Slok AHM. It Is Smart to Set Treatment Goals, But Are Set Treatment Goals SMART? A Qualitative Assessment of Goals Described in the Assessment of the Burden of COPD Tool. COPD 2023; 20:357-362. [PMID: 38178806 DOI: 10.1080/15412555.2023.2289908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024]
Abstract
The Assessment of the Burden of COPD (ABC) tool facilitates shared decision-making and goal setting to develop a personalized care plan. In a previous trial (RCT), the ABC tool was found to have a significant effect on patients' Health-related Quality of Life (HRQoL). In this exploratory study we used data from the intervention group of the RCT to investigate if patients with health-related goals had an improved HRQoL compared to those without goals, and if the quality and types of goals differed for those who have a clinically meaningful improvement in HRQoL. We hypothesized that the quality and the type of the goal described in the ABC tool, relates to an improved HRQoL. We assessed the quality of the goals according to the Specificity, Measurability, Achievability, Relevance and Timeliness (SMART) criteria, and coded and counted each type of goal. We found that having a goal or not, did not differ significantly for those who had a clinically meaningful improved HRQoL versus those who had not, nor was the quality or type of goal significantly different. The most common types of goals were exercise more, smoke less, and improve weight. Based on the results, we speculate that when a clinically meaningful improvement in HRQoL is achieved, it is not related to a single component (i.e. goal setting as part of shared decision-making) but that the different components of the ABC tool (visualization of burden, shared decision making, utilization of tailored evidence based interventions, and regular monitoring of progress) may have a synergistic effect on disease cognition and/or behavior change. Noteworthy, the sample size was small while the calculated effect size was moderate, making it unlikely to find a significant effect.
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Affiliation(s)
- M Voorhaar
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - O C P van Schayck
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - B Winkens
- Department of Methodology and Statistics, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - J W M Muris
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - A H M Slok
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
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Rawal T, Muris JWM, Mishra VK, Arora M, Tandon N, van Schayck OCP. Effect of an educational intervention on diet and physical activity among school-aged adolescents in Delhi -The i-PROMISe (PROMoting health literacy in Schools) Plus Study. Dialogues Health 2023; 2:100123. [PMID: 36919028 PMCID: PMC9991929 DOI: 10.1016/j.dialog.2023.100123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/21/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023]
Abstract
Purpose Emerging lifestyle changes due to rapid urbanization have led to an epidemiological transition and the rising prevalence of obesity is responsible for major non-communicable diseases (NCDs) which have further aggravated due to the COVID-19 pandemic. This study aims to assess the effectiveness of a comprehensive school-based intervention on diet and physical activity-related behavior of adolescents. Methods In 2019, a cluster-randomized controlled trial was conducted in randomly selected (n = 8) private schools. A 2-year intervention program was implemented over consecutive academic years (2019-2020 and 2020-2021) with students who were in the 6th and 7th grades when the study began. Four schools were randomly assigned to the intervention (n = 794) and four schools to the control group (n = 774). Results The difference in changes in diet and physical-activity-related behaviors of the students between the intervention and control schools were not significant in the intention to treat analysis probably due to the large drop-out due to COVID-19 measures: 304 students were available for follow-up in the intervention group and 122 in the control group (391 cases were excluded to make data comparable with baseline survey). The intake of vegetables (once a day) [β = 0.35, OR = 1.42, 95% CI (1.03, 1.95)] in the per-protocol analysis has increased among adolescents in the intervention group as compared to the control group. Conclusion The findings of this study indicated a positive effect of the intervention on diet and physical-activity-related changes in the expected direction and highlights the importance of addressing such behavior to prevent obesity among adolescents and thus NCDs in the later stage of life.
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Affiliation(s)
- Tina Rawal
- Health Promotion Division, Public Health Foundation of India, Gurgaon, India.,Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Jean W M Muris
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Vijay Kumar Mishra
- Health Promotion Division, Public Health Foundation of India, Gurgaon, India
| | - Monika Arora
- Health Promotion Division, Public Health Foundation of India, Gurgaon, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Snijkers JTW, Winkens B, Weerts ZZRM, Vork L, Mujagic Z, Hesselink MAM, Leue C, Kruimel JW, Muris JWM, Jonkers DMAE, Masclee AAM, Keszthelyi D. Satisfaction With Life in IBS Is Associated With Psychological Burden Rather than Gastrointestinal Symptom Severity. Am J Gastroenterol 2023:00000434-990000000-00906. [PMID: 37791610 PMCID: PMC10904003 DOI: 10.14309/ajg.0000000000002547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Irritable bowel syndrome (IBS) has a major impact on emotional, social, and professional life. This study aimed to evaluate general life satisfaction, a subjective measure of well-being, in IBS patients, and to determine which factors are associated with higher life satisfaction. METHODS IBS patients (n = 195, mean age 51.4 ± 16.5 years, 73.8% female) recruited from primary and secondary/tertiary care completed questionnaires regarding gastrointestinal symptoms, quality of life, psychological factors, and life satisfaction (Satisfaction With Life Scale, 5 items, range 5-35). A finite mixture model analysis was performed to identify latent classes. Multivariable linear regression was used to identify variables associated with life satisfaction. RESULTS Overall, 71.3% of the patients were satisfied about their life (Satisfaction With Life Scale-score ≥21). Three latent subgroups could be identified with significantly higher life satisfaction in the subgroup with higher mental quality of life, fewer anxiety and depressive symptoms, lower gastrointestinal specific anxiety, and lower gastrointestinal symptom severity, compared with the other 2 groups. Multivariable linear regression showed that higher physical quality of life (B0.168, P < 0.001) and higher mental quality of life (B0.199, P < 0.001) were associated with higher life satisfaction. Using multivariable regression, no significant association was found between gastrointestinal symptom severity and life satisfaction. DISCUSSION Higher physical and mental quality of life, but not gastrointestinal symptom severity, were independently associated with higher general life satisfaction in IBS. These findings reinforce the clinical need in IBS treatment to focus on the full extent of the disorder and not merely on gastrointestinal symptom improvement. ClinicalTrials.gov Identifier: NCT00775060.
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Affiliation(s)
- Johanna T W Snijkers
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Zsa Zsa R M Weerts
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Lisa Vork
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Zlatan Mujagic
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Martine A M Hesselink
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Carsten Leue
- MHeNS, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Psychiatry and Medical Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Joanna W Kruimel
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Jean W M Muris
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Daisy M A E Jonkers
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Ad A M Masclee
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
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Vork L, Mujagic Z, Masclee AAM, Muris JWM. [Irritable bowel syndrome]. Ned Tijdschr Geneeskd 2023; 167:D7704. [PMID: 37882441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Irritable bowel syndrome (IBS) is a prevalent disorder of the gut-brain interaction, of which the multifactorial pathophysiology is still incompletely understood. IBS is a symptom-based diagnosis based on the Rome IV criteria, and additional diagnostics are only indicated when history or physical examination point towards the presence of other (organic) disorders. Diagnosis and treatment should take place in primary care. However, management of IBS can be challenging due to the heterogenous clinical presentation. Furthermore, a variety of treatment options are available, yet only effective in subgroups of patients. Early positive diagnosis, patient education, and shared-decision making are of utmost importance in order to limit individual disease burden and the socioeconomic impact of IBS. In this review we discuss diagnosis, indications for additional investigations or referral to secondary care, and treatment of IBS, based on both the recently updated Dutch guideline and general practice standard on IBS.
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Affiliation(s)
- Lisa Vork
- Catharina Ziekenhuis, afd. Maag-, Darm- en Leverziekten, Eindhoven
- Contact: Lisa Vork
| | - Zlatan Mujagic
- Maastricht UMC+, afd. Maag-Darm-Leverziekten, Maastricht
| | - Ad A M Masclee
- Maastricht UMC+, afd. Maag-Darm-Leverziekten, Maastricht
| | - Jean W M Muris
- Maastricht UMC+, vakgroep Huisartsgeneeskunde, Maastricht
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van der Gulden R, Timmerman A, Muris JWM, Thoonen BPA, Heeneman S, Scherpbier-de Haan ND. How does portfolio use affect self-regulated learning in clinical workplace learning: What works, for whom, and in what contexts? Perspect Med Educ 2022; 11:247-257. [PMID: 36136233 PMCID: PMC9582105 DOI: 10.1007/s40037-022-00727-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Portfolio use to support self-regulated learning (SRL) during clinical workplace learning is widespread, but much is still unknown regarding its effectiveness. This review aimed to gain insight in the extent to which portfolio use supports SRL and under what circumstances. METHODS A realist review was conducted in two phases. First, stakeholder interviews and a scoping search were used to formulate a program theory that explains how portfolio use could support SRL. Second, an in-depth literature search was conducted. The included papers were coded to extract context-mechanism-outcome configurations (CMOs). These were synthesized to answer the research question. RESULTS Sixteen papers were included (four fulfilled all qualitative rigor criteria). Two primary portfolio mechanisms were established: documenting as a moment of contemplation (learners analyze experiences while writing portfolio reports) and documentation as a reminder of past events (previous portfolio reports aid recall). These mechanisms may explain the positive relationship between portfolio use and self-assessment, reflection, and feedback. However, other SRL outcomes were only supported to a limited extent: formulation of learning objectives and plans, and monitoring. The partial support of the program theory can be explained by interference of contextual factors (e.g., system of assessment) and portfolio-related mechanisms (e.g., mentoring). DISCUSSION Portfolio research is falling short both theoretically-in defining and conceptualizing SRL-and methodologically. Nevertheless, this review indicates that portfolio use has potential to support SRL. However, the working mechanisms of portfolio use are easily disrupted. These disruptions seem to relate to tensions between different portfolio purposes, which may undermine learners' motivation.
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Affiliation(s)
- Rozemarijn van der Gulden
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Angelique Timmerman
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Jean W M Muris
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Bart P A Thoonen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sylvia Heeneman
- Department of Pathology, Maastricht University, Maastricht, The Netherlands
| | - Nynke D Scherpbier-de Haan
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
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Hungin APS, Scarpignato C, Keefer L, Corsetti M, Anastasiou F, Muris JWM, Mendive JM, Kahrilas PJ. Review article: rethinking the "ladder" approach to reflux-like symptom management in the era of PPI "resistance" - a multidisciplinary perspective. Aliment Pharmacol Ther 2022; 55:1492-1500. [PMID: 35460095 PMCID: PMC9324949 DOI: 10.1111/apt.16930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/26/2021] [Accepted: 04/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite widespread adoption of potent acid suppression treatment with proton pump inhibitors (PPI) for reflux-like symptoms, persistent symptoms are commonly reported in primary care and community studies. AIMS This multidisciplinary review critically evaluates how the management of reflux-like symptoms could better reflect their multifactorial pathophysiology. METHODS A panel of experts (from general practice, gastroenterology and gastropsychology) attended a series of workshops to review current management and propose a framework for the provision of more individualised care. RESULTS It was agreed that the perceptual (as well as the physiological) causes of reflux-like symptoms should be considered at the start of management, not as a last resort when all else has failed. A short course of PPI is a pragmatic approach to address reflux-like symptoms, but equally important is counselling about the gut-brain axis and provision of symptom-specific behavioural interventions for those who show signs of somatisation, hypervigilance or co-existing disorders of gut-brain interaction. Other low-harm interventions such as lifestyle and dietary advice, should also be better integrated into care at an early stage. Multidisciplinary care management programmes (including dietary, weight loss, exercise and behavioural intervention) should be developed to promote greater self-management and take advantage of the general shift toward the use of remotely accessed health care resources. CONCLUSIONS Management of reflux-like symptoms should be adapted to reflect the advances in knowledge about the multifactorial aetiology of these symptoms, addressing both acid-related and behavioural components early in management. The time has come to treat the patient, not the "disease".
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Affiliation(s)
- A. Pali S. Hungin
- Primary Care and General Practice, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | | | - Laurie Keefer
- Icahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research CentreNottingham University Hospitals NHS TrustNottinghamUK,School of Medicine, University of Nottingham and Translational Medical Science – Nottingham Digestive Diseases CentreUniversity of NottinghamNottinghamUK
| | - Foteini Anastasiou
- 4th Local Primary Care TeamMunicipality Practice and Academic Practice of HeraklionCreteGreece
| | - Jean W. M. Muris
- Department of Family MedicineCare and Public Health Research Institute (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands
| | - Juan M. Mendive
- La Mina Primary Care Academic Centre, Catalan Health InstituteUniversity of BarcelonaBarcelonaSpain
| | - Peter J. Kahrilas
- Division of Gastroenterology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
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de Jonge LPJWM, Minkels FNE, Govaerts MJB, Muris JWM, Kramer AWM, van der Vleuten CPM, Timmerman AA. Supervisory dyads' communication and alignment regarding the use of workplace-based observations: a qualitative study in general practice residency. BMC Med Educ 2022; 22:330. [PMID: 35484573 PMCID: PMC9052511 DOI: 10.1186/s12909-022-03395-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In medical residency, performance observations are considered an important strategy to monitor competence development, provide feedback and warrant patient safety. The aim of this study was to gain insight into whether and how supervisor-resident dyads build a working repertoire regarding the use of observations, and how they discuss and align goals and approaches to observation in particular. METHODS We used a qualitative, social constructivist approach to explore if and how supervisory dyads work towards alignment of goals and preferred approaches to performance observations. We conducted semi-structured interviews with supervisor-resident dyads, performing a template analysis of the data thus obtained. RESULTS The supervisory dyads did not frequently communicate about the use of observations, except at the start of training and unless they were triggered by internal or external factors. Their working repertoire regarding the use of observations seemed to be primarily driven by patient safety goals and institutional assessment requirements rather than by providing developmental feedback. Although intended as formative, the institutional test was perceived as summative by supervisors and residents, and led to teaching to the test rather than educating for purposes of competence development. CONCLUSIONS To unlock the full educational potential of performance observations, and to foster the development of an educational alliance, it is essential that supervisory dyads and the training institute communicate clearly about these observations and the role of assessment practices of- and for learning, in order to align their goals and respective approaches.
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Affiliation(s)
- Laury P J W M de Jonge
- Department of General Practice, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Floor N E Minkels
- Department of General Practice, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Marjan J B Govaerts
- Department of Educational Research and Development, Maastricht University, Maastricht, The Netherlands
| | - Jean W M Muris
- Department of General Practice, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Anneke W M Kramer
- Department of Family Medicine, Leiden University, Leiden, The Netherlands
| | - Cees P M van der Vleuten
- Department of Educational Research and Development, Maastricht University, Maastricht, The Netherlands
| | - Angelique A Timmerman
- Department of General Practice, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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Assmann SL, Keszthelyi D, Kleijnen J, Anastasiou F, Bradshaw E, Brannigan AE, Carrington EV, Chiarioni G, Ebben LDA, Gladman MA, Maeda Y, Melenhorst J, Milito G, Muris JWM, Orhalmi J, Pohl D, Tillotson Y, Rydningen M, Svagzdys S, Vaizey CJ, Breukink SO. Guideline for the diagnosis and treatment of Faecal Incontinence-A UEG/ESCP/ESNM/ESPCG collaboration. United European Gastroenterol J 2022; 10:251-286. [PMID: 35303758 PMCID: PMC9004250 DOI: 10.1002/ueg2.12213] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 02/02/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The goal of this project was to create an up-to-date joint European clinical practice guideline for the diagnosis and treatment of faecal incontinence (FI), using the best available evidence. These guidelines are intended to help guide all medical professionals treating adult patients with FI (e.g., general practitioners, surgeons, gastroenterologists, other healthcare workers) and any patients who are interested in information regarding the diagnosis and management of FI. METHODS These guidelines have been created in cooperation with members from the United European Gastroenterology (UEG), European Society of Coloproctology (ESCP), European Society of Neurogastroenterology and Motility (ESNM) and the European Society for Primary Care Gastroenterology (ESPCG). These members made up the guideline development group (GDG). Additionally, a patient advisory board (PAB) was created to reflect and comment on the draft guidelines from a patient perspective. Relevant review questions were established by the GDG along with a set of outcomes most important for decision making. A systematic literature search was performed using these review questions and outcomes as a framework. For each predefined review question, the study or studies with the highest level of study design were included. If evidence of a higher-level study design was available, no lower level of evidence was sought or included. Data from the studies were extracted by two reviewers for each predefined important outcome within each review question. Where possible, forest plots were created. After summarising the results for each review question, a systematic quality assessment using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach was performed. For each review question, we assessed the quality of evidence for every predetermined important outcome. After evidence review and quality assessment were completed, recommendations could be formulated. The wording used for each recommendation was dependent on the level of quality of evidence. Lower levels of evidence resulted in weaker recommendations and higher levels of evidence resulted in stronger recommendations. Recommendations were discussed within the GDG to reach consensus. RESULTS These guidelines contain 45 recommendations on the classification, diagnosis and management of FI in adult patients. CONCLUSION These multidisciplinary European guidelines provide an up-to-date comprehensive evidence-based framework with recommendations on the diagnosis and management of adult patients who suffer from FI.
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Affiliation(s)
- Sadé L. Assmann
- Department of Surgery and Colorectal SurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Jos Kleijnen
- School for Oncology and Developmental Biology (GROW)Maastricht UniversityMaastrichtThe Netherlands
| | - Foteini Anastasiou
- 4rth TOMY – Academic Primary Care Unit Clinic of Social and Family MedicineUniversity of CreteHeraklionGreece
| | - Elissa Bradshaw
- Community Gastroenterology Specialist NurseRoyal Free HospitalLondonEnglandUK
| | | | - Emma V. Carrington
- Surgical Professorial UnitDepartment of Colorectal SurgerySt Vincent's University HospitalDublinIreland
| | - Giuseppe Chiarioni
- Division of Gastroenterology of the University of VeronaAOUI VeronaVeronaItaly
- Center for Functional GI and Motility DisordersUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | - Marc A. Gladman
- The University of AdelaideAdelaide Medical SchoolFaculty of Health & Medical SciencesAdelaideAustralia
| | - Yasuko Maeda
- Department of Surgery and Colorectal SurgeryWestern General HospitalEdinburghUK
| | - Jarno Melenhorst
- Department of Surgery and Colorectal SurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
- School for Oncology and Developmental Biology (GROW)Maastricht UniversityMaastrichtThe Netherlands
| | | | - Jean W. M. Muris
- Department of General PracticeCare and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | | | - Daniel Pohl
- Department of Gastroenterology and HepatologyUniversity Hospital ZurichZurichSwitzerland
- Department of Gastrointestinal SurgeryUniversity Hospital of North NorwayTromsøNorway
| | | | - Mona Rydningen
- Norwegian National Advisory Unit on Incontinence and Pelvic Floor HealthTromsøNorway
| | - Saulius Svagzdys
- Medical AcademyLithuanian University of Health SciencesClinic of Surgery Hospital of Lithuanian University of Health Sciences Kauno KlinikosKaunasLithuania
| | | | - Stephanie O. Breukink
- Department of Surgery and Colorectal SurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM)Maastricht UniversityMaastrichtThe Netherlands
- School for Oncology and Developmental Biology (GROW)Maastricht UniversityMaastrichtThe Netherlands
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11
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Zijlstra DN, Hoving C, Bolman C, Muris JWM, De Vries H. Do professional perspectives on evidence-based smoking cessation methods align? A Delphi study among researchers and healthcare professionals. Health Educ Res 2022; 36:434-445. [PMID: 34195810 PMCID: PMC8783547 DOI: 10.1093/her/cyab022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 04/02/2021] [Accepted: 05/20/2021] [Indexed: 06/13/2023]
Abstract
The use of evidence-based smoking cessation interventions (SCIs) can significantly increase the number of successful smoking cessation attempts. To obtain an overview of the knowledge and viewpoints on the effectiveness and use of SCIs, a three-round online Delphi study was conducted among researchers and primary care professionals (PCPs). The four objectives of this study are to gain an overview of (i) the criteria important for recommending SCIs, (ii) the perceptions of both groups on the effectiveness of SCIs, (iii) the factors to consider when counseling different (high-risk) groups of smokers and (iv) the perceptions of both groups on the use of e-cigarettes as an SCI. We found a high level of agreement within groups on which smoker characteristics should be considered when recommending an SCI to smokers. We also found that PCPs display a lower degree of consensus on the effectiveness of SCIs. Both groups see a value in the use of special protocols for different (high-risk) groups of patients, but the two groups did not reach consensus on the use of e-cigarettes as a means to quit. Making an inventory of PCPs' needs regarding SCIs and their usage may provide insight into how to facilitate a better uptake in the primary care setting.
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Affiliation(s)
| | - Ciska Hoving
- Department of Health Promotion, CAPHRI, Maastricht University, Peter Debyeplein 1, Maastricht 6229 HA, Netherlands
| | - Catherine Bolman
- Department of Psychology, Open University of the Netherlands, P.O. Box 2960, Heerlen 6401 DL, Netherlands
| | - Jean W M Muris
- Department of General Practice, CAPHRI, Maastricht University, Peter Debyeplein 1, Maastricht 6229 HA, Netherlands
| | - Hein De Vries
- Department of Health Promotion, CAPHRI, Maastricht University, Peter Debyeplein 1, Maastricht 6229 HA, Netherlands
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12
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Snijkers JTW, van den Oever W, Weerts ZZRM, Vork L, Mujagic Z, Leue C, Hesselink MAM, Kruimel JW, Muris JWM, Bogie RMM, Masclee AAM, Jonkers DMAE, Keszthelyi D. Examining the optimal cutoff values of HADS, PHQ-9 and GAD-7 as screening instruments for depression and anxiety in irritable bowel syndrome. Neurogastroenterol Motil 2021; 33:e14161. [PMID: 33938601 PMCID: PMC9285971 DOI: 10.1111/nmo.14161] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/23/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Self-rating scales are frequently used to screen for anxiety and depression in patients with irritable bowel syndrome (IBS). Different cutoff values are recommended in literature, and guidelines have suggested the use of other screening instruments over time. The aim of this study was to assess the correlation between the most commonly used psychological screening instruments for anxiety and depression in IBS and to compare custom cutoff scores for these instruments. METHODS Irritable bowel syndrome patients (n = 192) completed several questionnaires including the Hospital Anxiety and Depression Scale (HADS, HADS-A and HADS-D subscale), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Agreement at different cutoff points, for depressive and anxiety disorder, was assessed by use of the Gwet AC1 coefficient. KEY RESULTS Hospital Anxiety and Depression Scale (HADS)-D and PHQ-9 scores, and HADS-A and GAD-7 scores showed high correlations (rs = 0.735 and rs = 0.805, respectively). For depressive disorder, a Gwet AC1 value of 0.829 was found when recommended cutoff points from literature were compared (PHQ-9 cutoff ≥10, HADS-D cutoff ≥8). For anxiety disorder, a Gwet AC1 value of 0.806 was found when recommended cutoff points from literature were compared (GAD-7 cutoff ≥10, HADS-A cutoff ≥8). Even higher agreements were found when higher HADS cutoff values were chosen, with impact on sensitivity and specificity. CONCLUSIONS & INFERENCES Custom cutoff values deem the HADS subscales (HADS-D and HADS-A) concordant to PHQ-9 and GAD-7 scores. The choice of a cutoff value has substantial impact on sensitivity/specificity and is dependent on patient population, setting, and the purpose of use.
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Affiliation(s)
- Johanna T. W. Snijkers
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Wendy van den Oever
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Zsa Zsa R. M. Weerts
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Lisa Vork
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Zlatan Mujagic
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Carsten Leue
- Department of Psychiatry and PsychologyMaastricht University Medical Center+MaastrichtThe Netherlands,MHeNSSchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Martine A. M. Hesselink
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Joanna W. Kruimel
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Jean W. M. Muris
- Department of Family MedicineCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Roel M. M. Bogie
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,GROWSchool for Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
| | - Ad A. M. Masclee
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Daisy M. A. E. Jonkers
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology‐HepatologyDepartment of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,NUTRIMSchool of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
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13
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Latten GHP, Polak J, Merry AHH, Muris JWM, Ter Maaten JC, Olgers TJ, Cals JWL, Stassen PM. Frequency of alterations in qSOFA, SIRS, MEWS and NEWS scores during the emergency department stay in infectious patients: a prospective study. Int J Emerg Med 2021; 14:69. [PMID: 34837940 PMCID: PMC8903686 DOI: 10.1186/s12245-021-00388-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For emergency department (ED) patients with suspected infection, a vital sign-based clinical rule is often calculated shortly after the patient arrives. The clinical rule score (normal or abnormal) provides information about diagnosis and/or prognosis. Since vital signs vary over time, the clinical rule scores can change as well. In this prospective multicentre study, we investigate how often the scores of four frequently used clinical rules change during the ED stay of patients with suspected infection. METHODS Adult (≥ 18 years) patients with suspected infection were prospectively included in three Dutch EDs between March 2016 and December 2019. Vital signs were measured in 30-min intervals and the quick Sequential Organ Failure Assessment (qSOFA) score, the Systemic Inflammatory Response Syndrome (SIRS) criteria, the Modified Early Warning Score and the National Early Warning Score (NEWS) score were calculated. Using the established cut-off points, we analysed how often alterations in clinical rule scores occurred (i.e. switched from normal to abnormal or vice versa). In addition, we investigated which vital signs caused most alterations. RESULTS We included 1433 patients, of whom a clinical rule score changed once or more in 637 (44.5%) patients. In 6.7-17.5% (depending on the clinical rule) of patients with an initial negative clinical rule score, a positive score occurred later during ED stay. In over half (54.3-65.0%) of patients with an initial positive clinical rule score, the score became negative later on. The respiratory rate caused most (51.2%) alterations. CONCLUSION After ED arrival, alterations in qSOFA, SIRS, MEWS and/or NEWS score are present in almost half of patients with suspected infection. The most contributing vital sign to these alterations was the respiratory rate. One in 6-15 patients displayed an abnormal clinical rule score after a normal initial score. Clinicians should be aware of the frequency of these alterations in clinical rule scores, as clinical rules are widely used for diagnosis and/or prognosis and the optimal moment of assessing them is unknown.
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Affiliation(s)
- Gideon H P Latten
- Emergency Department, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
| | - Judith Polak
- Emergency Department, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - Audrey H H Merry
- Zuyderland Academy, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Jean W M Muris
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jan C Ter Maaten
- Department of Internal Medicine, section acute internal medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Tycho J Olgers
- Department of Internal Medicine, section acute internal medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jochen W L Cals
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Patricia M Stassen
- Department of Internal Medicine, division general medicine, section acute medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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14
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Zijlstra DN, Bolman CAW, Muris JWM, de Vries H. The Usability of an Online Tool to Promote the Use of Evidence-Based Smoking Cessation Interventions. Int J Environ Res Public Health 2021; 18:10836. [PMID: 34682582 PMCID: PMC8535528 DOI: 10.3390/ijerph182010836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 01/23/2023]
Abstract
To increase usage of evidence-based smoking cessation interventions (EBSCIs) among smokers, an online decision aid (DA) was developed. The aims of this study were (1) to conduct a usability evaluation; (2) to conduct a program evaluation and evaluate decisional conflict after using the DA and (3) to determine the possible change in the intention to use EBSCIs before and directly after reviewing the DA. A cross-sectional study was carried out in September 2020 by recruiting smokers via the Internet (n = 497). Chi-squared tests and t-tests were conducted to test the differences between smokers who differed in the perceived usability of the DA on the program evaluation and in decisional conflict. The possible changes in intention to use EBSCIs during a cessation attempt before and after reviewing the DA were tested using t-tests, McNemar's test and χ2 analysis. The participants evaluated the usability of the DA as moderate (MU; n = 393, 79.1%) or good (GU; n = 104, 20.9%). GU smokers rated higher on all the elements of the program evaluation and experienced less decisional conflict, but also displayed a higher intention to quit. After reviewing the DA, the participants on average had a significantly higher intention to use more EBSCIs, in particular in the form of eHealth. Recommendations to make the DA more usable could include tailoring, using video-based information and including value clarification methods. Furthermore, a hybrid variant in which smokers can use the DA independently and with the guidance of a primary care professional could aid both groups in choosing a fitting EBSCI option.
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Affiliation(s)
- Daniëlle N. Zijlstra
- Department of Health Promotion, Maastricht University/CAPHRI, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands;
| | - Catherine A. W. Bolman
- Department of Psychology, Open University of the Netherlands, Valkenburgerweg 177, 6419 AT Heerlen, The Netherlands;
| | - Jean W. M. Muris
- Department of General Practice, Maastricht University/CAPHRI, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands;
| | - Hein de Vries
- Department of Health Promotion, Maastricht University/CAPHRI, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands;
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15
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Gültzow T, Zijlstra DN, Bolman C, de Vries H, Dirksen CD, Muris JWM, Smit ES, Hoving C. Decision aids to facilitate decision making around behavior change in the field of health promotion: A scoping review. Patient Educ Couns 2021; 104:1266-1285. [PMID: 33531158 DOI: 10.1016/j.pec.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To broadly synthesize literature regarding decision aids (DAs) supporting decision making about diet, physical activity, sleeping and substance use a scoping review was performed. METHODS Multiple sources were used: (1) Scientific literature searches, (2) excluded references from a Cochrane review regarding DAs for treatments and screenings, and (3) results from additional searches. Interventions had to (1) support informed decision making and (2) provide information and help to choose between at least two options. Two researchers screened titles and abstracts. Relevant information was extracted descriptively. RESULTS Thirty-five scientific articles and four DAs (grey literature) were included. Results were heterogeneous. Twenty-nine (94%) studies described substance use DAs. All DAs offered information and value and/or preference clarification. Many other elements were included (e.g., goal-setting). DA's effects were mixed. Few studies used standardized measures, e.g., decisional conflict (n = 4, 13%). Some positive behavioral effects were reported: e.g., smoking abstinence (n = 1). CONCLUSIONS This research shows only some positive behavioral effects of DAs. However, studies reported heterogeneous results/outcomes, impeding knowledge synthesis. Areas of improvement were identified, e.g., establishing which intervention elements are effective regarding health behavior decision making. PRACTICE IMPLICATIONS DAs can potentially be beneficial in supporting people to change health behaviors - especially regarding smoking.
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Affiliation(s)
- Thomas Gültzow
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands.
| | - Daniëlle N Zijlstra
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Catherine Bolman
- Faculty of Psychology, Open University of the Netherlands, the Netherlands
| | - Hein de Vries
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Carmen D Dirksen
- CAPHRI Care and Public Health Research Institute, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jean W M Muris
- CAPHRI Care and Public Health Research Institute, Department of General Practice, Maastricht University, Maastricht, the Netherlands
| | - Eline S Smit
- University of Amsterdam, Amsterdam School of Communication Research/ASCoR, Department of Communication Science, Amsterdam, the Netherlands
| | - Ciska Hoving
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
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16
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Kuiper SZ, Dirksen CD, Kimman ML, Van Kuijk SMJ, Van Tol RR, Muris JWM, Watson AJM, Maessen JMC, Melenhorst J, Breukink SO. Effectiveness and cost-effectiveness of rubber band ligation versus sutured mucopexy versus haemorrhoidectomy in patients with recurrent haemorrhoidal disease (Napoleon trial): Study protocol for a multicentre randomized controlled trial. Contemp Clin Trials 2020; 99:106177. [PMID: 33080380 DOI: 10.1016/j.cct.2020.106177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Currently, there is no consensus regarding the best treatment option in recurrent haemorrhoidal disease (HD), due to a lack of solid evidence. The Napoleon trial aims to provide high-level evidence on the comparative effectiveness and cost-effectiveness of repeat rubber band ligation (RBL) versus sutured mucopexy versus haemorrhoidectomy in patients with recurrent HD. METHODS This is a multicentre randomized controlled trial. Patients with recurrent HD grade II and III, ≥18 years of age and who had at least two RBL treatments in the last three years are eligible for inclusion. Exclusion criteria include previous rectal or anal surgery, rectal radiation, pre-existing sphincter injury or otherwise pathologies of the colon and rectum, pregnancy, presence of hypercoagulability disorders, and medically unfit for surgery (ASA > III). Between June 2020 and May 2022, 558 patients will be randomized to receive either: (1) RBL, (2) sutured mucopexy, or (3) haemorrhoidectomy. The primary outcomes are recurrence after 52 weeks and patient-reported symptoms measured by the PROM-HISS. Secondary outcomes are impact on daily life, treatment satisfaction, early and late complication rates, health-related quality of life, costs and cost-effectiveness, and budget impact. Cost-effectiveness will be expressed in societal costs per Quality Adjusted Life Year (QALY) (based on EQ-5D-5L), and healthcare costs per recurrence avoided. DISCUSSION The best treatment option for recurrent HD remains unknown. The comparison of three generally accepted treatment strategies in a randomized controlled trial will provide high-level evidence on the most (cost-) effective treatment. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04101773.
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Affiliation(s)
- Sara Z Kuiper
- Department of Surgery, Maastricht University, School of Nutrition and Translational Research in Metabolism (NUTRIM), Universiteitssingel 50, 6229, ER, Maastricht, the Netherlands.
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Oxfordlaan 10, 6202, AZ, Maastricht, the Netherlands
| | - Merel L Kimman
- Department of Clinical Epidemiology and Medical Technology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Oxfordlaan 10, 6202, AZ, Maastricht, the Netherlands
| | - Sander M J Van Kuijk
- Department of Clinical Epidemiology and Medical Technology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Oxfordlaan 10, 6202, AZ, Maastricht, the Netherlands
| | - Robin R Van Tol
- Department of Surgery, Diakonessenhuis Medical Centre, Bosboomstraat 1, 3582, KE, Utrecht, the Netherlands
| | - Jean W M Muris
- Department of Family Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6229, ER, Maastricht, the Netherlands
| | - Angus J M Watson
- Department of Surgery, Raigmore Hospital, Old Perth Road, IV2 3UJ Inverness, United Kingdom
| | - Jose M C Maessen
- Department of Quality and Safety, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Stéphanie O Breukink
- Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Department of Surgery, Maastricht University, School of Nutrition and Translational Research in Metabolism (NUTRIM), School for Oncology and Developmental Biology (GROW), Universiteitssingel 50, 6229, ER, Maastricht, the Netherlands
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17
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Keszthelyi D, Muris JWM. [Constipation]. Ned Tijdschr Geneeskd 2020; 164:D5052. [PMID: 33201627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Constipation is an everyday complaint in general practice and in secondary care. In a limited number of situations, constipation is an alarm signal of a serious condition. In this postgraduate learning article, we discuss possible causes, the role of history and physical examination, additional diagnostics and treatment of constipation.
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Affiliation(s)
- Daniel Keszthelyi
- Maastricht Universitair Medisch Centrum (MUMC+), divisie Maag-darm-leverziekten, afd. Interne Geneeskunde, Maastricht
| | - Jean W M Muris
- Universiteit Maastricht, vakgroep Huisartsgeneeskunde, Maastricht
- Contact: Jean W.M. Muris
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18
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Latten G, Hensgens K, de Bont EGPM, Muris JWM, Cals JWL, Stassen P. How well are sepsis and a sense of urgency documented throughout the acute care chain in the Netherlands? A prospective, observational study. BMJ Open 2020; 10:e036276. [PMID: 32690518 PMCID: PMC7371221 DOI: 10.1136/bmjopen-2019-036276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the documentation of sepsis and a sense of urgency throughout the acute care chain. DESIGN Prospective cohort study. SETTING Emergency department (ED) in a large district hospital in Heerlen, The Netherlands. PARTICIPANTS Participants included patients ≥18 years with suspected sepsis who visited the ED during out-of-hours between September 2017 and January 2018 (n=339) and had been referred by a general practitioner and/or transported by ambulance. We defined suspected sepsis as suspected or proven infection and the presence of ≥2 quick Sepsis-related Organ Failure Assessment and/or ≥2 Systemic Inflammatory Response Syndrome criteria. OUTCOME MEASURES We analysed how often sepsis and a sense of urgency were documented in the prehospital and ED medical records. A sense of urgency was considered documented when a medical record suggested the need of immediate assessment by a physician in the ED. We described documentation patterns throughout the acute care chain and investigated whether documentation of sepsis or a sense of urgency is associated with adverse outcomes (intensive care admission/30-day all-cause mortality). RESULTS Sepsis was documented in 16.8% of medical records and a sense of urgency in 22.4%. In 4.1% and 7.7%, respectively, sepsis and a sense of urgency were documented by all involved professionals. In patients with an adverse outcome, sepsis was documented more often in the ED than in patients without an adverse outcome (47.9% vs 13.7%, p<0.001). CONCLUSIONS Our study shows that in prehospital and ED medical records, sepsis and a sense of urgency are documented in one out of five patients. In only 1 out of 20 patients sepsis or a sense of urgency is documented by all involved professionals. It is possible that poor documentation causes harm, due to delayed diagnosis or treatment. Hence, it could be important to raise awareness among professionals regarding the importance of their documentation.
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Affiliation(s)
- Gideon Latten
- Emergency Department, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Kirsten Hensgens
- Emergency Department, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Eefje G P M de Bont
- Family Medicine, Maastricht University, Research Institute CAPHRI, Maastricht, Limburg, The Netherlands
| | - Jean W M Muris
- Family Medicine, Maastricht University, Research Institute CAPHRI, Maastricht, Limburg, The Netherlands
| | - Jochen W L Cals
- Family Medicine, Maastricht University, Research Institute CAPHRI, Maastricht, Limburg, The Netherlands
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19
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Voorhaar M, Tiemensma J, Asijee GM, Slok AHM, Muris JWM, Kaptein AA. A TASMAN Expedition: Development of a Questionnaire to Assess Specific Self-Management Abilities. Int J Chron Obstruct Pulmon Dis 2020; 15:1415-1423. [PMID: 32606650 PMCID: PMC7310989 DOI: 10.2147/copd.s224943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/17/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Self-management (SM) is a core component of well-being and perceived health for patients with chronic obstructive pulmonary disease (COPD). Most theories on SM share that self-efficacy, illness-perception and coping are determinants of SM behavior. Optimal support to improve SM should be tailored to the individual patient’s level of these determinants as SM abilities vary between patients. To tailor SM support, it is therefore necessary to assess the scores on these determinants. Unfortunately, no such instrument exists for clinical use. Therefore, the first goal of this study was to verify presumed correlations between SM and the determinants thereof. The second goal was to develop an instrument to assess the SM abilities. Methods In this cross-sectional, observational study, COPD patients completed the General Self-Efficacy Scale (GSES), Brief Illness Perception Questionnaire (B-IPQ) and the Utrecht Proactive Coping Competence measure (UPCC) as well as the Self-Management Ability Scale (SMAS-30). Correlations between the questionnaires were assessed and a principal component analysis (PCA) was performed to identify the best-fitting items in the three independent variables related to SM. These items were used to create an instrument to assess SM abilities. Results Hundred COPD patients (58 males, 41 females, 1 unknown) were included. The correlation between SM and self-efficacy, illness perception on concerns and proactive coping was moderate and significant (r=0.318, p<0.01; r=−.230, p<0.05; r=.426, p<0.01, respectively). PCA identified six UPCC items and nine GSES items that met the predefined criteria. These items were supplemented with the B-IPQ concerns item to establish the new instrument to assess SM abilities.
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Affiliation(s)
- M Voorhaar
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - J Tiemensma
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - G M Asijee
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - A H M Slok
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - J W M Muris
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - A A Kaptein
- Department of Medical Psychology, Leiden University Medical Centre, Leiden, the Netherlands
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20
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van Tol RR, Kleijnen J, Watson AJM, Jongen J, Altomare DF, Qvist N, Higuero T, Muris JWM, Breukink SO. European Society of ColoProctology: guideline for haemorrhoidal disease. Colorectal Dis 2020; 22:650-662. [PMID: 32067353 DOI: 10.1111/codi.14975] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 01/03/2020] [Indexed: 12/15/2022]
Abstract
AIM The goal of this European Society of ColoProctology project was to establish a multidisciplinary, international guideline for haemorrhoidal disease (HD) and to provide guidance on the most effective (surgical) treatment for patients with HD. METHODS The development process consisted of six phases. In phase one we defined the scope of the guideline. The patient population included patients with all stages of haemorrhoids. The target group for the guideline was all practitioners treating patients with haemorrhoids and, in addition, healthcare workers and patients who desired information regarding the treatment management of HD. The guideline needed to address both the diagnosis of and the therapeutic modalities for HD. Phase two consisted of the compilation of the guideline development group (GDG). All clinical members needed to have affinity with the diagnosis and treatment of haemorrhoids. Further, attention was paid to the geographical distribution of the clinicians. Each GDG member identified at least one patient in their country who could read English to comment on the draft guideline. In phase three review questions were formulated, using a reversed process, starting with possible recommendations based on the GDG's knowledge. In phase four a literature search was performed in MEDLINE (Ovid), PubMed, Embase (Ovid) and the Cochrane Database of Systematic Reviews. The search was focused on existing systematic reviews addressing each review question, supplemented by other studies published after the time frame covered by the systematic reviews. In phase five data of the included papers were extracted by the surgical resident (RT) and checked by the methodologist (JK) and the GDG. If needed, meta-analysis of the systematic reviews was updated by the surgical resident and the methodologist using Review Manager. During phase six the GDG members decided what recommendations could be made based on the evidence found in the literature using GRADE. RESULTS There were six sections: (i) symptoms, diagnosis and classification; (ii) basic treatment; (iii) outpatient procedures; (iv) surgical interventions; (v) special situations; (vi) other surgical techniques. Thirty-four recommendations were formulated. CONCLUSION This international, multidisciplinary guideline provides an up to date and evidence based summary of the current knowledge of the management of HD and may serve as a useful guide for patients and clinicians.
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Affiliation(s)
- R R van Tol
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J Kleijnen
- Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - A J M Watson
- Department of Surgery, Raigmore Hospital, Inverness, UK
| | - J Jongen
- Department of Surgical Proctology, Proktologische Praxis Kiel,, Kiel, Germany
| | - D F Altomare
- Department of Emergency and Organ Transplantation, University of Aldo Moro of Bari, Bari, Italy
| | - N Qvist
- Surgical Department A, Odense University Hospital, Odense C, Denmark
| | - T Higuero
- Clinique Saint Antoine, Nice, France
| | - J W M Muris
- Department of Family Medicine/General Practice, Research Institute CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - S O Breukink
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
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21
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de Jonge LPJWM, Mesters I, Govaerts MJB, Timmerman AA, Muris JWM, Kramer AWM, van der Vleuten CPM. Supervisors' intention to observe clinical task performance: an exploratory study using the theory of planned behaviour during postgraduate medical training. BMC Med Educ 2020; 20:134. [PMID: 32354331 PMCID: PMC7193388 DOI: 10.1186/s12909-020-02047-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/21/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND Direct observation of clinical task performance plays a pivotal role in competency-based medical education. Although formal guidelines require supervisors to engage in direct observations, research demonstrates that trainees are infrequently observed. Supervisors may not only experience practical and socio-cultural barriers to direct observations in healthcare settings, they may also question usefulness or have low perceived self-efficacy in performing direct observations. A better understanding of how these multiple factors interact to influence supervisors' intention to perform direct observations may help us to more effectively implement the aforementioned guidelines and increase the frequency of direct observations. METHODS We conducted an exploratory quantitative study, using the Theory of Planned Behaviour (TPB) as our theoretical framework. In applying the TPB, we transfer a psychological theory to medical education to get insight in the influence of cognitive and emotional processes on intentions to use direct observations in workplace based learning and assessment. We developed an instrument to investigate supervisors intention to perform direct observations. The relationships between the TPB measures of our questionnaire were explored by computing bivariate correlations using Pearson's R tests. Hierarchical regression analysis was performed in order to assess the impact of the respective TPB measures as predictors on the intention to perform direct observations. RESULTS In our study 82 GP supervisors completed our TPB questionnaire. We found that supervisors had a positive attitude towards direct observations. Our TPB model explained 45% of the variance in supervisors' intentions to perform them. Normative beliefs and past behaviour were significant determinants of this intention. CONCLUSION Our study suggests that supervisors use their past experiences to form intentions to perform direct observations in a careful, thoughtful manner and, in doing so, also take the preferences of the learner and other stakeholders potentially engaged in direct observations into consideration. These findings have potential implications for research into work-based assessments and the development of training interventions to foster a shared mental model on the use of direct observations.
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Affiliation(s)
- Laury P J W M de Jonge
- Department of General Practice, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Ilse Mesters
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Marjan J B Govaerts
- Department of Educational Research and Development, Maastricht University, Maastricht, The Netherlands
| | - Angelique A Timmerman
- Department of General Practice, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Jean W M Muris
- Department of General Practice, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Anneke W M Kramer
- Department of Family Medicine, Leiden University, Leiden, The Netherlands
| | - Cees P M van der Vleuten
- Department of Educational Research and Development, Maastricht University, Maastricht, The Netherlands
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22
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Nakken N, Janssen DJA, Wouters EFM, Bogaart EHA, Muris JWM, Vries GJ, Bootsma GP, Gronenschild MHM, Delbressine JML, Vliet M, Spruit MA. Changes in problematic activities of daily living in persons with COPD during 1 year of usual care. Aust Occup Ther J 2020; 67:447-457. [DOI: 10.1111/1440-1630.12664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Nienke Nakken
- Department of Research and Development CIRO Horn the Netherlands
| | - Daisy J. A. Janssen
- Department of Research and Development CIRO Horn the Netherlands
- Department of Health Services Research CAPHRI Faculty of Health Medicine and Life Sciences Maastricht University Maastricht the Netherlands
| | - Emiel F. M. Wouters
- Department of Research and Development CIRO Horn the Netherlands
- Department of Respiratory Medicine Maastricht University Medical Centre+ (MUMC+) Maastricht the Netherlands
- Department of Respiratory Medicine NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht University Medical Centre+ (MUMC+) Maastricht The Netherlands
| | | | - Jean W. M. Muris
- Department of Family Medicine CAPHRI Care and Public Health Research Institute Maastricht University Maastricht the Netherlands
| | - Geeuwke J. Vries
- Department of Respiratory Medicine Zuyderland Sittard‐Geleen the Netherlands
| | - Gerben P. Bootsma
- Department of Respiratory Medicine Zuyderland Heerlen the Netherlands
| | | | | | - Monique Vliet
- Department of Respiratory Medicine Zuyderland Heerlen the Netherlands
| | - Martijn A. Spruit
- Department of Research and Development CIRO Horn the Netherlands
- Department of Respiratory Medicine NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht University Medical Centre+ (MUMC+) Maastricht The Netherlands
- Reval Rehabilitation Research Biomedical Research Institute Faculty of Rehabilitation Sciences Hasselt University Diepenbeek Belgium
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23
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Goërtz YMJ, Spruit MA, Van 't Hul AJ, Peters JB, Van Herck M, Nakken N, Djamin RS, Burtin C, Thong MSY, Coors A, Meertens-Kerris Y, Wouters EFM, Prins JB, Franssen FME, Muris JWM, Vanfleteren LEGW, Sprangers MAG, Janssen DJA, Vercoulen JH. Fatigue is highly prevalent in patients with COPD and correlates poorly with the degree of airflow limitation. Ther Adv Respir Dis 2020; 13:1753466619878128. [PMID: 31558115 PMCID: PMC6767724 DOI: 10.1177/1753466619878128] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: The objective of this study was to compare fatigue levels between subjects
with and without COPD, and to investigate the relationship between fatigue,
demographics, clinical features and disease severity. Methods: A total of 1290 patients with COPD [age 65 ± 9 years, 61% male, forced
expiratory volume in 1 s (FEV1) 56 ± 19% predicted] and 199 subjects without
COPD (age 63 ± 9 years, 51% male, FEV1 112 ± 21% predicted) were assessed
for fatigue (Checklist Individual Strength-Fatigue), demographics, clinical
features and disease severity. Results: Patients with COPD had a higher mean fatigue score, and a higher proportion
of severe fatigue (CIS-Fatigue score 35 ± 12 versus
21 ± 11 points, p < 0.001; 49 versus
10%, p < 0.001). Fatigue was significantly, but poorly,
associated with the degree of airflow limitation [FEV1 (% predicted)
Spearman correlation coefficient = −0.08, p = 0.006].
Multiple regression indicated that 30% of the variance in fatigue was
explained by the predictor variables. Conclusions: Severe fatigue is prevalent in half of the patients with COPD, and correlates
poorly with the degree of airflow limitation. Future studies are needed to
better understand the physical, psychological, behavioural, and systemic
factors that precipitate or perpetuate fatigue in COPD.
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Affiliation(s)
- Yvonne M J Goërtz
- Department of Research and Education, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, NM 6085, the Netherlands
| | - Martijn A Spruit
- Department of Research and Education, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, NM, the Netherlands.,REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Alex J Van 't Hul
- Department of Pulmonary Disease, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jeannette B Peters
- Department of Pulmonary Disease, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Maarten Van Herck
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Nienke Nakken
- Department of Research and Education, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Remco S Djamin
- Department of Respiratory Medicine, Amphia Ziekenhuis, Breda, the Netherlands
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Melissa S Y Thong
- Department of Medical Psychology, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands
| | - Arnold Coors
- Member of the Patient Advisory Board, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Yvonne Meertens-Kerris
- Member of the Patient Advisory Board, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Emiel F M Wouters
- Department of Research and Education, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Frits M E Franssen
- Department of Research and Education, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Jean W M Muris
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Lowie E G W Vanfleteren
- Department of Research and Education, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.,COPD Center, Sahlgrenska University, Gothenburg, Sweden
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands
| | - Daisy J A Janssen
- Department of Research and Education, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.,Centre of Expertise for Palliative Care, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Jan H Vercoulen
- Department of Pulmonary Disease, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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24
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Conchillo JM, van den Beuken-van Everdingen MHJ, Muris JWM, Masclee AAM. [Nausea; article for education and training purposes]. Ned Tijdschr Geneeskd 2020; 164:D3978. [PMID: 32267634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Nausea is a common presenting symptom in medical care with a broad differential diagnosis. In this teaching article we provide practical information on many aspects of nausea including pathophysiology and differential diagnosis, history and physical examination, and diagnostic tests and treatment. This was done by means of answering several questions from the daily practice of general practitioners, specialists in internal medicine and surgeons. In a patient with nausea a provisional diagnosis can be made based on medical history, careful history-taking and age. Diagnostic testing is only performed on clinical suspicion and depends on the provisional diagnosis and presence of alarm symptoms. Tailored medical treatment of nausea is based on the provisional diagnosis and on the mechanism of action of the intended antiemetic agent.
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Affiliation(s)
- J M Conchillo
- Maastricht UMC+, Maastricht, afd. Maag-darm-leverziekten, Maastricht
- Contact: J.M. Conchillo
| | | | - J W M Muris
- Maastricht University, vakgroep Huisartsgeneeskunde, Maastricht
| | - A A M Masclee
- Maastricht UMC+, Maastricht, afd. Maag-darm-leverziekten, Maastricht
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25
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Weerts ZZRM, Masclee AAM, Witteman BJM, Clemens CHM, Winkens B, Brouwers JRBJ, Frijlink HW, Muris JWM, De Wit NJ, Essers BAB, Tack J, Snijkers JTW, Bours AMH, de Ruiter-van der Ploeg AS, Jonkers DMAE, Keszthelyi D. Efficacy and Safety of Peppermint Oil in a Randomized, Double-Blind Trial of Patients With Irritable Bowel Syndrome. Gastroenterology 2020; 158:123-136. [PMID: 31470006 DOI: 10.1053/j.gastro.2019.08.026] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/05/2019] [Accepted: 08/14/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Peppermint oil is frequently used to treat irritable bowel syndrome (IBS), despite a lack of evidence for efficacy from high-quality controlled trials. We studied the efficacy and safety of small-intestinal-release peppermint oil in patients with IBS and explored the effects of targeted ileocolonic-release peppermint oil. METHODS We performed a double-blind trial of 190 patients with IBS (according to Rome IV criteria) at 4 hospitals in The Netherlands from August 2016 through March 2018; 189 patients were included in the intent-to-treat analysis (mean age, 34.0 years; 77.8% female; 57.7% in primary care), and 178 completed the study. Patients were randomly assigned to groups given 182 mg small-intestinal-release peppermint oil, 182 mg ileocolonic-release peppermint oil, or placebo for 8 weeks. The primary endpoint was abdominal pain response, as defined by the US Food and Drug Administration: at least a 30% decrease in the weekly average of worst daily abdominal pain compared with baseline in at least 4 weeks. The co-primary endpoint was overall relief of IBS symptoms, as defined by the European Medicines Agency. Secondary endpoints included abdominal pain, discomfort, symptom severity, and adverse events. RESULTS Abdominal pain response did not differ significantly between the peppermint oil and placebo groups: 29 of 62 patients in the small-intestinal-release peppermint oil group had a response (46.8%, P = .170 vs placebo), 26 of 63 patients in the ileocolonic-release peppermint oil group had a response (41.3%, P = .385 vs placebo), and 22 of 64 patients in the placebo group had a response (34.4%). We did not find differences among the groups in overall relief (9.7%, P = .317 and 1.6%, P = .351 vs 4.7% for placebo). The small intestinal peppermint oil did, however, produce greater improvements than placebo in secondary outcomes of abdominal pain (P = .016), discomfort (P = .020), and IBS severity (P = .020). Adverse events, although mild, were more common in both peppermint oil groups (P < .005). CONCLUSIONS In a randomized trial of patients with IBS, we found that neither small-intestinal-release nor ileocolonic-release peppermint oil (8 weeks) produced statistically significant reductions in abdominal pain response or overall symptom relief, when using US Food and Drug Administration/European Medicines Agency recommended endpoints. The small-intestinal-release peppermint oil did, however, significantly reduce abdominal pain, discomfort, and IBS severity. These findings do not support further development of ileocolonic-release peppermint oil for treatment of IBS. Clinicaltrials.gov, Number: NCT02716285.
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Affiliation(s)
- Zsa Zsa R M Weerts
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Ad A M Masclee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ben J M Witteman
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands; Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Cees H M Clemens
- Department of Gastroenterology, Alrijne Zorggroep, Leiden, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jacobus R B J Brouwers
- Unit of Pharmacotherapy, Epidemiology, and Economics, University of Groningen, Groningen Research Institute of Pharmacy, The Netherlands
| | - Henderik W Frijlink
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen Research Institute of Pharmacy, The Netherlands
| | - Jean W M Muris
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Niek J De Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Brigitte A B Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Tack
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Diseases (TARGID), University of Leuven, Leuven, Belgium
| | - Johanna T W Snijkers
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andrea M H Bours
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Daisy M A E Jonkers
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
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26
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Mujagic Z, Weerts ZZRM, Vork L, Leue C, Kruimel JW, Hesselink M, Muris JWM, Jonkers DMAE, Masclee AAM, Keszthelyi D. Quality of life in irritable bowel syndrome: Authors' reply. Neurogastroenterol Motil 2020; 32:e13729. [PMID: 31854094 DOI: 10.1111/nmo.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Zlatan Mujagic
- Division of Gastroenterology-Hepatology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Zsa Zsa R M Weerts
- Division of Gastroenterology-Hepatology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Lisa Vork
- Division of Gastroenterology-Hepatology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Carsten Leue
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joanna W Kruimel
- Division of Gastroenterology-Hepatology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Martine Hesselink
- Division of Gastroenterology-Hepatology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jean W M Muris
- Department of Family Medicine, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Daisy M A E Jonkers
- Division of Gastroenterology-Hepatology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ad A M Masclee
- Division of Gastroenterology-Hepatology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
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Latten GHP, Spek M, Muris JWM, Cals JWL, Stassen PM. Accuracy and interobserver-agreement of respiratory rate measurements by healthcare professionals, and its effect on the outcomes of clinical prediction/diagnostic rules. PLoS One 2019; 14:e0223155. [PMID: 31581207 PMCID: PMC6776326 DOI: 10.1371/journal.pone.0223155] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/13/2019] [Indexed: 11/26/2022] Open
Abstract
Objective In clinical prediction/diagnostic rules aimed at early detection of critically ill patients, the respiratory rate plays an important role. We investigated the accuracy and interobserver-agreement of respiratory rate measurements by healthcare professionals, and the potential effect of incorrect measurements on the scores of 4 common clinical prediction/diagnostic rules: Systemic Inflammatory Response Syndrome (SIRS) criteria, quick Sepsis-related Organ Failure Assessment (qSOFA), National Early Warning Score (NEWS), and Modified Early Warning Score (MEWS). Methods Using an online questionnaire, we showed 5 videos with a healthy volunteer, breathing at a fixed (true) rate (13–28 breaths/minute). Respondents measured the respiratory rate, and categorized it as low, normal, or high. We analysed how accurate the measurements were using descriptive statistics, and calculated interobserver-agreement using the intraclass correlation coefficient (ICC), and agreement between measurements and categorical judgments using Cohen’s Kappa. Finally, we analysed how often incorrect measurements led to under/overestimation in the selected clinical rules. Results In total, 448 healthcare professionals participated. Median measurements were slightly higher (1-3/min) than the true respiratory rate, and 78.2% of measurements were within 4/min of the true rate. ICC was moderate (0.64, 95% CI 0.39–0.94). When comparing the measured respiratory rates with the categorical judgments, 14.5% were inconsistent. Incorrect measurements influenced the 4 rules in 8.8% (SIRS) to 37.1% (NEWS). Both underestimation (4.5–7.1%) and overestimation (3.9–32.2%) occurred. Conclusions The accuracy and interobserver-agreement of respiratory rate measurements by healthcare professionals are suboptimal. This leads to both over- and underestimation of scores of four clinical prediction/diagnostic rules. The clinically most important effect could be a delay in diagnosis and treatment of (critically) ill patients.
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Affiliation(s)
- Gideon H. P. Latten
- Emergency Department, Zuyderland Medical Centre, Heerlen, The Netherlands
- Department of Family Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
- * E-mail:
| | - Michelle Spek
- Department of Internal Medicine, division general medicine, section acute medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Jean W. M. Muris
- Department of Family Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Jochen W. L. Cals
- Department of Family Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Patricia M. Stassen
- Department of Internal Medicine, division general medicine, section acute medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Van Herck M, Antons J, Vercoulen JH, Goërtz YMJ, Ebadi Z, Burtin C, Janssen DJA, Thong MSY, Otker J, Coors A, Sprangers MAG, Muris JWM, Prins JB, Spruit MA, Peters JB. Pulmonary Rehabilitation Reduces Subjective Fatigue in COPD: A Responder Analysis. J Clin Med 2019; 8:E1264. [PMID: 31434343 PMCID: PMC6722504 DOI: 10.3390/jcm8081264] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 12/20/2022] Open
Abstract
To date, it remains unknown which patients report a clinically-relevant improvement in fatigue following pulmonary rehabilitation (PR). The purpose of this study was to identify and characterize these responders. Demographics, lung function, anxiety (anxiety subscale of the 90-item symptom checklist (SCL-90-A)), depression (Beck depression inventory for primary care (BDI-PC)), exercise tolerance (six-minute walking distance test (6MWD)), and health status (Nijmegen clinical screening instrument (NCSI)) were assessed before and after a 12-week PR programme. Fatigue was assessed using the checklist individual strength (CIS)-Fatigue. Patients with a decline ≥ 10 points (minimally clinically important difference, MCID) on the CIS-Fatigue were defined as responders. Chronic obstructive pulmonary disease (COPD) patients (n = 446, 61 ± 9 years, 53% male, forced expiratory volume in 1 s (FEV1) 43% ± 18% predicted, 75% severe fatigue) were included. Mean change in fatigue after PR was 10 ± 12 points (p < 0.01) and exceeded the MCID. In total, 56% were identified as fatigue responders. Baseline CIS-Fatigue (45 ± 7 vs. 38 ± 9 points, respectively, p < 0.001) and health-related quality-of-life (HRQoL; p < 0.001) were different between responders and non-responders. No differences were found in demographics, baseline anxiety, depression, lung function, 6MWD, and dyspnoea (p-values > 0.01). Responders on fatigue reported a greater improvement in anxiety, depression, 6MWD, dyspnoea (all p-values < 0.001), and most health status parameters. PR reduces fatigue in COPD. Responders on fatigue have worse fatigue and HRQoL scores at baseline, and are also likely to be responders on other outcomes of PR.
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Affiliation(s)
- Maarten Van Herck
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
- Department of Research and Development, CIRO+, Center of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands.
| | - Jeanine Antons
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Pulmonary Diseases, 6525 GA Nijmegen, The Netherlands
| | - Jan H Vercoulen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, 6525 GA Nijmegen, The Netherlands
| | - Yvonne M J Goërtz
- Department of Research and Development, CIRO+, Center of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands
| | - Zjala Ebadi
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, 6525 GA Nijmegen, The Netherlands
| | - Chris Burtin
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Daisy J A Janssen
- Department of Research and Development, CIRO+, Center of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands
- Centre of Expertise for Palliative Care, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
| | - Melissa S Y Thong
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Jacqueline Otker
- Member of Lung Foundation Netherlands, 3818 LE Amersfoort, The Netherlands
| | - Arnold Coors
- Member of Patient Advisory Board, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Jean W M Muris
- Department of General Practice, CAPHRI Research Institute, 6229 HX Maastricht, The Netherlands
| | - Judith B Prins
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, 6525 GA Nijmegen, The Netherlands
| | - Martijn A Spruit
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- Department of Research and Development, CIRO+, Center of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, 6229 ER Maastricht, The Netherlands
| | - Jeannette B Peters
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, 6525 GA Nijmegen, The Netherlands
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Roebroek YGM, Talib A, Muris JWM, van Dielen FMH, Bouvy ND, van Heurn LWE. Hurdles to Take for Adequate Treatment of Morbidly Obese Children and Adolescents: Attitudes of General Practitioners Towards Conservative and Surgical Treatment of Paediatric Morbid Obesity. World J Surg 2019; 43:1173-1181. [PMID: 30478687 DOI: 10.1007/s00268-018-4874-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Bariatric surgery is regarded as the most effective treatment of morbid obesity in adults. Referral patterns for bariatric surgery in adults differ among general practitioners (GPs), partially due to restricted knowledge of the available treatment options. Reluctance in referral might be present even stronger in the treatment of morbidly obese children. OBJECTIVES The aim of this study was to investigate the current practice of GPs regarding treatment of paediatric morbid obesity and their attitudes towards the emergent phenomenon of paediatric weight loss surgery. METHODS All GPs enlisted in the local registries of two medical centres were invited for a 15-question anonymous online survey. RESULTS Among 534 invited GPs, 184 (34.5%) completed the survey. Only 102 (55.4%) reported providing or referring morbidly obese children for combined lifestyle interventions. A majority (n = 175, 95.1%) estimated that conservative treatment is effective in a maximum of 50% of children. Although 123 (66.8%) expect that bariatric surgery may be effective in therapy-resistant morbid obesity, only 76 (41.3%) would consider referral for surgery. Important reasons for reluctance were uncertainty about long-term efficacy and safety. The opinion that surgery is only treatment of symptoms and therefore not appropriate was significantly more prevalent amongst GPs who would not refer (58.3% vs. 27.6%, p < 0.001). CONCLUSION There is a potential for undertreatment of morbidly obese adolescents, due to suboptimal knowledge regarding guidelines and bariatric surgery, as well as negative attitudes towards surgery. This should be addressed by improving communication between surgeons and GPs and providing educational resources on bariatric surgery.
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Affiliation(s)
- Yvonne G M Roebroek
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, NL-6229 HX, Maastricht, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Ali Talib
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, NL-6229 HX, Maastricht, The Netherlands
| | - Jean W M Muris
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, NL-6229 HX, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - L W Ernest van Heurn
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Center/VU University Medical Center, Amsterdam, The Netherlands
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Latten GHP, Claassen L, Jonk M, Cals JWL, Muris JWM, Stassen PM. Characteristics of the prehospital phase of adult emergency department patients with an infection: A prospective pilot study. PLoS One 2019; 14:e0212181. [PMID: 30730990 PMCID: PMC6366787 DOI: 10.1371/journal.pone.0212181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/29/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Research on serious infections/sepsis has focused on the hospital environment, while potentially the most delay, and therefore possibly the best opportunity to improve quality of care, lies in the prehospital setting. In this study we investigated the prehospital phase of adult emergency department (ED) patients with an infection. METHODS In this prospective pilot study all adult (≥18y) patients with a suspected/proven infection, based on the notes in the patient's ED chart, were included during a 4-week period in 2017. Prehospital course, ED findings, presence of sepsis and 30-day outcomes were registered. RESULTS A total of 440 patients were identified, with a median symptom duration before ED visit of 3 days (IQR 1-7 days). Before arrival in the ED, 23.9% of patients had used antibiotics. Most patients (83.0%) had been referred by a general practitioner (GP), while 41.1% of patients had visited their GP previously during the current disease episode. Patients referred by a GP were triaged as high-urgency less often, while vital parameters were similar. Emergency Medical Services (EMS) transported 268 (60.9%) of patients. Twenty-two patients (5.0%) experienced an adverse outcome (30-day all-cause mortality and/or admission to intensive care). CONCLUSIONS Patients with a suspected infection had symptoms for 3 (IQR 1-7) days at the moment of presentation to the ED. During this prehospital phase patients often had consulted, and were treated by, their GP. Many were transported to the ED by EMS. Future research on severe infections should focus on the prehospital phase, targeting patients and primary care professionals.
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Affiliation(s)
- Gideon H. P. Latten
- Emergency Department, Zuyderland Medisch Centrum, Heerlen, The Netherlands
- * E-mail:
| | - Lieke Claassen
- Emergency Department, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - Marnix Jonk
- Emergency Department, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - Jochen W. L. Cals
- Department of Family Medicine, Maastricht University, School of CAPHRI, Maastricht, The Netherlands
| | - Jean W. M. Muris
- Department of Family Medicine, Maastricht University, School of CAPHRI, Maastricht, The Netherlands
| | - Patricia M. Stassen
- Department of Internal Medicine, Division General Medicine, Section Acute Medicine, Maastricht University, School of CAPHRI, Maastricht, The Netherlands
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Van Herck M, Spruit MA, Burtin C, Djamin R, Antons J, Goërtz YMJ, Ebadi Z, Janssen DJA, Vercoulen JH, Peters JB, Thong MSY, Otker J, Coors A, Sprangers MAG, Muris JWM, Wouters EFM, van 't Hul AJ. Fatigue is Highly Prevalent in Patients with Asthma and Contributes to the Burden of Disease. J Clin Med 2018; 7:E471. [PMID: 30477110 PMCID: PMC6306949 DOI: 10.3390/jcm7120471] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 12/17/2022] Open
Abstract
The 2018 update of the Global Strategy for Asthma Management and Prevention does not mention fatigue-related symptoms. Nevertheless, patients with asthma frequently report tiredness, lack of energy, and daytime sleepiness. Quantitative research regarding the prevalence of fatigue in asthmatic patients is lacking. This retrospective cross-sectional study of outpatients with asthma upon referral to a chest physician assessed fatigue (Checklist Individual Strength-Fatigue (CIS-Fatigue)), lung function (spirometry), asthma control (Asthma Control Questionnaire (ACQ)), dyspnea (Medical Research Council (MRC) scale), exercise capacity (six-minute walk test (6MWT)), and asthma-related Quality-of-Life (QoL), Asthma Quality of Life Questionnaire (AQLQ) during a comprehensive health-status assessment. In total, 733 asthmatic patients were eligible and analyzed (47.4 ± 16.3 years, 41.1% male). Severe fatigue (CIS-Fatigue ≥ 36 points) was detected in 62.6% of patients. Fatigue was not related to airflow limitation (FEV1, ρ = -0.083); was related moderately to ACQ (ρ = 0.455), AQLQ (ρ = -0.554), and MRC (ρ = 0.435; all p-values < 0.001); and was related weakly to 6MWT (ρ = -0.243, p < 0.001). In stepwise multiple regression analysis, 28.9% of variance in fatigue was explained by ACQ (21.0%), MRC (6.5%), and age (1.4%). As for AQLQ, 42.2% of variance was explained by fatigue (29.8%), MRC (8.6%), exacerbation rate (2.6%), and age (1.2%). Severe fatigue is highly prevalent in asthmatic patients; it is an important determinant of disease-specific QoL and a crucial yet ignored patient-related outcome in patients with asthma.
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Affiliation(s)
- Maarten Van Herck
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands.
| | - Martijn A Spruit
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands.
- Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), 6229 HX Maastricht, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, 6229 ER Maastricht, The Netherlands.
| | - Chris Burtin
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
| | - Remco Djamin
- Department of Respiratory Medicine, Amphia Hospital, 4818 CK Breda, The Netherlands.
| | - Jeanine Antons
- Department of Pulmonary Medicine, Radboud University Medical Center (Radboudumc), 6525 GA Nijmegen, The Netherlands.
| | - Yvonne M J Goërtz
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands.
| | - Zjala Ebadi
- Department of Medical Psychology, Radboudumc, 6525 GA Nijmegen, The Netherlands.
| | - Daisy J A Janssen
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands.
- Centre of expertise for palliative care, MUMC+, 6229 HX Maastricht, The Netherlands.
| | - Jan H Vercoulen
- Department of Medical Psychology, Radboudumc, 6525 GA Nijmegen, The Netherlands.
| | - Jeannette B Peters
- Department of Medical Psychology, Radboudumc, 6525 GA Nijmegen, The Netherlands.
| | - Melissa S Y Thong
- Department of Medical Psychology, Amsterdam University Medical Centers, location AMC, 1105 AZ Amsterdam, The Netherlands.
| | - Jacqueline Otker
- Member of Lung Foundation Netherlands, 3818 LE Amersfoort, The Netherlands.
| | - Arnold Coors
- Member of Patient Advisory Board, Radboudumc, 6525 GA Nijmegen, The Netherlands.
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, location AMC, 1105 AZ Amsterdam, The Netherlands.
| | - Jean W M Muris
- Department of General Practice, MUMC+, 6229 HX Maastricht, The Netherlands.
| | - Emiel F M Wouters
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands.
- Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), 6229 HX Maastricht, The Netherlands.
| | - Alex J van 't Hul
- Department of Pulmonary Medicine, Radboud University Medical Center (Radboudumc), 6525 GA Nijmegen, The Netherlands.
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Nakken N, Spruit MA, van den Bogaart EHA, Crutzen R, Muris JWM, Wouters EFM, Janssen DJA. Identifying causes of perceptual differences in problematic activities of daily life between patients with COPD and proxies: A qualitative study. Aust Occup Ther J 2018; 66:44-51. [DOI: 10.1111/1440-1630.12512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Nienke Nakken
- Department of Research & Education; CIRO; Horn The Netherlands
| | - Martijn A. Spruit
- Department of Research & Education; CIRO; Horn The Netherlands
- Department of Respiratory Medicine; NUTRIM School of Nutrition and Translational Research in Metabolism; Maastricht University Medical Centre+ (MUMC+); Maastricht The Netherlands
| | | | - Rik Crutzen
- Department of Health Promotion; CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
| | - Jean W. M. Muris
- Department of Family Medicine; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
| | - Emiel F. M. Wouters
- Department of Research & Education; CIRO; Horn The Netherlands
- Department of Respiratory Medicine; Maastricht University Medical Centre+ (MUMC+); Maastricht The Netherlands
| | - Daisy J. A. Janssen
- Department of Research & Education; CIRO; Horn The Netherlands
- Centre of Expertise for Palliative Care; Maastricht University Medical Centre+ (MUMC+); Maastricht The Netherlands
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33
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Goërtz YMJ, Looijmans M, Prins JB, Janssen DJA, Thong MSY, Peters JB, Burtin C, Meertens-Kerris Y, Coors A, Muris JWM, Sprangers MAG, Wouters EFM, Vercoulen JH, Spruit MA. Fatigue in patients with chronic obstructive pulmonary disease: protocol of the Dutch multicentre, longitudinal, observational FAntasTIGUE study. BMJ Open 2018; 8:e021745. [PMID: 29643168 PMCID: PMC5898336 DOI: 10.1136/bmjopen-2018-021745] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Fatigue is the second most common symptom in patients with chronic obstructive pulmonary disease (COPD). Despite its high prevalence, fatigue is often ignored in daily practice. For this reason, little is known about the underlying determinants of fatigue in patients with COPD. The primary objectives of this study are to chart the course of fatigue in patients with COPD, to identify the physical, systemic, psychological and behavioural factors that precipitate and perpetuate fatigue in patients with COPD, to evaluate the impact of exacerbation-related hospitalisations on fatigue and to better understand the association between fatigue and 2-year all-cause hospitalisation and mortality in patients with COPD. The secondary aim is to identify diurnal differences in fatigue by using ecological momentary assessment (EMA). This manuscript describes the protocol of the FAntasTIGUE study and gives an overview of the possible strengths, weaknesses and clinical implications. METHODS AND ANALYSIS A 2-year longitudinal, observational study, enrolling 400 patients with clinically stable COPD has been designed. Fatigue, the primary outcome, will be measured by the subjective fatigue subscale of the Checklist Individual Strength (CIS-Fatigue). The secondary outcome is the day-to-day/diurnal fatigue, registered in a subsample (n=60) by EMA. CIS-Fatigue and EMA will be evaluated at baseline, and at 4, 8 and 12 months. The precipitating and perpetuating factors of fatigue (physical, psychological, behavioural and systemic) will be assessed at baseline and at 12 months. Additional assessments will be conducted following hospitalisation due to an exacerbation of COPD that occurs between baseline and 12 months. Finally, at 18 and 24 months the participants will be followed up on their fatigue, number of exacerbations, exacerbation-related hospitalisation and survival. ETHICS AND DISSEMINATION This protocol was approved by the Medical research Ethics Committees United, Nieuwegein, the Netherlands (NL60484.100.17). TRIAL REGISTRATION NUMBER NTR6933; Pre-results.
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Affiliation(s)
- Yvonne M J Goërtz
- Department of Research and Education, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Milou Looijmans
- Department of Medical Psychology and Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology and Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Daisy J A Janssen
- Department of Research and Education, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Melissa S Y Thong
- Department of Medical Psychology, Academic Medical Centre University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jeannette B Peters
- Department of Medical Psychology and Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Yvonne Meertens-Kerris
- Patient Advisory Board, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Arnold Coors
- Patient Advisory Board, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jean W M Muris
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Academic Medical Centre University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Emiel F M Wouters
- Department of Research and Education, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Jan H Vercoulen
- Department of Medical Psychology and Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Martijn A Spruit
- Department of Research and Education, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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Vork L, Weerts ZZRM, Mujagic Z, Kruimel JW, Hesselink MAM, Muris JWM, Keszthelyi D, Jonkers DMAE, Masclee AAM. Rome III vs Rome IV criteria for irritable bowel syndrome: A comparison of clinical characteristics in a large cohort study. Neurogastroenterol Motil 2018; 30. [PMID: 28804974 DOI: 10.1111/nmo.13189] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/20/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The Rome criteria for irritable bowel syndrome (IBS) have been revised and are expected to apply only to the subset of Rome III IBS subjects with abdominal pain as predominant symptom, occurring at least once a week. The aim of this study was to determine the percentage of Rome III IBS subjects that fulfills Rome IV criteria and to evaluate differences between Rome IV-positive and Rome IV-negative subjects. METHODS Four hundred and four Rome III IBS subjects completed a 14-day end-of-day symptom diary, the Gastrointestinal Symptom Rating Scale (GSRS), Hospital Anxiety and Depression Scale, and RAND 36-item Short-Form Health Survey (SF-36). Diary-based surrogate Rome IV criteria were defined as occurrence of abdominal pain at least 1 day each week with a severity of ≥2 (mild; definition 1) or ≥3 (considerable; definition 2). KEY RESULTS Using surrogate Rome IV criteria, 353 (87.4%, definition 1) and 249 (61.6%, definition 2) subjects were defined as Rome IV positive. These patients were more often female, younger, and recruited from secondary/tertiary care compared with Rome IV-negative subjects. They also presented with higher abdominal pain scores and gastrointestinal (GI) symptom severity on both end-of-day diary and GSRS, higher psychological symptom scores, and lower quality of life compared with Rome IV-negative subjects. CONCLUSIONS AND INFERENCES The Rome IV IBS population likely reflects a subgroup of Rome III IBS patients with more severe GI symptomatology, psychological comorbidities, and lower quality of life. This implies that results from Rome III IBS studies may not be directly comparable to those from Rome IV IBS populations.
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Affiliation(s)
- L Vork
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Z Z R M Weerts
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Z Mujagic
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J W Kruimel
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M A M Hesselink
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J W M Muris
- Department of Family Medicine, CAPHRI Care And Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - D Keszthelyi
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - D M A E Jonkers
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A A M Masclee
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
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Hutchinson SG, van Schayck CP, Muris JWM, Feron FJM, Dompeling E. Recruiting families for an intervention study to prevent second-hand smoke exposure in children. BMC Pediatr 2018; 18:19. [PMID: 29386032 PMCID: PMC5793411 DOI: 10.1186/s12887-018-0983-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/04/2018] [Indexed: 11/20/2022] Open
Abstract
Background We evaluated the effectiveness of different recruitment strategies used in a study aimed at eliminating/reducing second-hand smoke (SHS) exposure in Dutch children 0–13 years of age with a high risk of asthma. Methods The different strategies include: 1) questionnaires distributed via home addresses, physicians or schools of the children; 2) cohorts from other paediatric studies; 3) physicians working in the paediatric field (family physicians, paediatricians and Youth Health Care (YHC) physicians); and 4) advertisements in a local newsletter, at child-care facilities, and day-care centres. Results More than 42,782 families were approached to take part in the screening of which 3663 could be assessed for eligibility. Of these responders, 196 families met the inclusion criteria for the study. However, only 58 (one third) could be randomised in the trial, mainly because of no interest or time of the parents. The results showed that recruiting families who expose their children to SHS exposure is very challenging, which may be explained by lack of ‘recognition’ or awareness that SHS occurs in homes. The presence of asthma in the family, respiratory symptoms in the children, and even incentives did not increase parental motivation for participation in the study. Conclusions The recruitment process for an intervention program addressing SHS exposure in children was considerably more challenging and time consuming than anticipated. Barriers at both a parents level and a doctor’s level can be discriminated. Electronic supplementary material The online version of this article (10.1186/s12887-018-0983-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sasha G Hutchinson
- Department of Paediatric Respiratory Medicine, Maastricht University Medical Centre (MUMC+) / CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Constant P van Schayck
- Department of Family Medicine, MUMC+ / CAPHRI, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Jean W M Muris
- Department of Family Medicine, MUMC+ / CAPHRI, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Frans J M Feron
- Department of Social Medicine, MUMC+ / CAPHRI, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Edward Dompeling
- Department of Paediatric Respiratory Medicine, Maastricht University Medical Centre (MUMC+) / CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200, MD, Maastricht, the Netherlands.
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Giroldi E, Freeth R, Hanssen M, Muris JWM, Kay M, Cals JWL. Family Physicians Managing Medical Requests From Family and Friends. Ann Fam Med 2018; 16:45-51. [PMID: 29311174 PMCID: PMC5758319 DOI: 10.1370/afm.2152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 06/19/2017] [Accepted: 07/11/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Although guidelines generally state that physicians should not treat their family members or friends (nonpatients), physicians regularly receive medical requests from nonpatients. We aimed to explore junior and senior family physicians' experiences with and attitudes toward managing medical requests from nonpatients. METHODS We conducted a qualitative study with 7 focus groups with junior and senior physicians. We performed a thematic analysis during an iterative cycle of data collection and analysis. RESULTS When confronted with a medical request from a nonpatient, physicians first oriented themselves to the situation: who is this person, what is he or she asking of me, and where are we? Physicians next considered the following interrelated factors: (1) nature/strength of the relationship with the nonpatient, (2) amount of trust in his/her own knowledge and skills, (3) expected consequences of making mistakes, (4) importance of work-life balance, and (5) risk of disturbing the physician-patient process. Senior physicians applied more nuanced considerations when deciding whether to respond, whereas junior physicians experienced more difficulties dealing with these requests, were less inclined to respond, and were more concerned about disturbing the existing relationship that a person had with his/her own physician. CONCLUSIONS This study provides insight into the complexity that physicians face when managing medical questions and requests from nonpatients. Facilitated group discussions during which experiences are shared can help junior physicians become more confident in dealing with these complex issues as they formulate their own personal strategy regarding provision of medical advice or treatment to family and friends.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands .,Department of Educational Development and Research, Maastricht University, School of Health Professions Education (SHE), Maastricht, The Netherlands
| | - Robin Freeth
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Maurice Hanssen
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Jean W M Muris
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Margareth Kay
- Discipline of General Practice, The University of Queensland, Herston, Australia
| | - Jochen W L Cals
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
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de Jonge LPJWM, Timmerman AA, Govaerts MJB, Muris JWM, Muijtjens AMM, Kramer AWM, van der Vleuten CPM. Stakeholder perspectives on workplace-based performance assessment: towards a better understanding of assessor behaviour. Adv Health Sci Educ Theory Pract 2017; 22:1213-1243. [PMID: 28155004 PMCID: PMC5663793 DOI: 10.1007/s10459-017-9760-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 01/24/2017] [Indexed: 05/13/2023]
Abstract
Workplace-Based Assessment (WBA) plays a pivotal role in present-day competency-based medical curricula. Validity in WBA mainly depends on how stakeholders (e.g. clinical supervisors and learners) use the assessments-rather than on the intrinsic qualities of instruments and methods. Current research on assessment in clinical contexts seems to imply that variable behaviours during performance assessment of both assessors and learners may well reflect their respective beliefs and perspectives towards WBA. We therefore performed a Q methodological study to explore perspectives underlying stakeholders' behaviours in WBA in a postgraduate medical training program. Five different perspectives on performance assessment were extracted: Agency, Mutuality, Objectivity, Adaptivity and Accountability. These perspectives reflect both differences and similarities in stakeholder perceptions and preferences regarding the utility of WBA. In comparing and contrasting the various perspectives, we identified two key areas of disagreement, specifically 'the locus of regulation of learning' (i.e., self-regulated versus externally regulated learning) and 'the extent to which assessment should be standardised' (i.e., tailored versus standardised assessment). Differing perspectives may variously affect stakeholders' acceptance, use-and, consequently, the effectiveness-of assessment programmes. Continuous interaction between all stakeholders is essential to monitor, adapt and improve assessment practices and to stimulate the development of a shared mental model. Better understanding of underlying stakeholder perspectives could be an important step in bridging the gap between psychometric and socio-constructivist approaches in WBA.
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Affiliation(s)
- Laury P J W M de Jonge
- Department of Family Medicine, FHML, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Angelique A Timmerman
- Department of Family Medicine, FHML, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Marjan J B Govaerts
- Department of Educational Research and Development, FHML, Maastricht University, Maastricht, The Netherlands
| | - Jean W M Muris
- Department of Family Medicine, FHML, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Arno M M Muijtjens
- Department of Educational Research and Development, FHML, Maastricht University, Maastricht, The Netherlands
| | - Anneke W M Kramer
- Department of Family Medicine, Leiden University, Leiden, The Netherlands
| | - Cees P M van der Vleuten
- Department of Educational Research and Development, FHML, Maastricht University, Maastricht, The Netherlands
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Hutchinson SG, van Breukelen G, van Schayck CP, Essers B, Hammond SK, Muris JWM, Feron FJM, Dompeling E. Motivational interviewing and urine cotinine feedback to stop passive smoke exposure in children predisposed to asthma: a randomised controlled trial. Sci Rep 2017; 7:15473. [PMID: 29133798 PMCID: PMC5684321 DOI: 10.1038/s41598-017-15158-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 10/18/2017] [Indexed: 02/01/2023] Open
Abstract
We tested the effectiveness of a program consisting of motivational interviewing (MI) and feedback of urine cotinine to stop passive smoking (PS) in children at risk for asthma. Fifty-eight families with children 0-13 years with a high risk of asthma and PS exposure were randomised in a one-year follow-up study. The intervention group received the intervention program during 6 sessions (1/month) and the control group received measurements (questionnaires, urine cotinine, and lung function) only. The primary outcome measure was the percentage of families stopping PS (parental report verified and unverified with the child's urine cotinine concentration <10 μg/l) in children during the intervention program. The analyses were performed with Mixed Logistic Regression. After 6 months, a significant group difference was observed for the unverified parental report of stopping PS in children: 27% of parents in the intervention group versus 7% in the control group. For the verified parental report, the difference was similar (23% versus 7%) but was not statistically significant. Despite a limited sample size, the results suggest that the intervention program is probably an effective strategy to stop PS in children. A program longer than 6 months might be necessary for a longer lasting intervention effect.
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Affiliation(s)
- Sasha G Hutchinson
- Department of Paediatric Pulmonology, Maastricht University Medical Center (MUMC+)/CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Gerard van Breukelen
- Department of Methodology and Statistics, MUMC+/CAPHRI, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Constant P van Schayck
- Department of Family Medicine, MUMC+/CAPHRI, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Brigitte Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, MUMC+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - S Katharine Hammond
- School of Public Health, University of California, Mail/140 Warren, Berkeley, CA, 94720-7360, USA
| | - Jean W M Muris
- Department of Family Medicine, MUMC+/CAPHRI, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Frans J M Feron
- Department of Social Medicine, MUMC+/CAPHRI, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Edward Dompeling
- Department of Paediatric Pulmonology, Maastricht University Medical Center (MUMC+)/CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Meuwissen JMJE, Heynens J, Dauven T, Crasborn L, Smeenk FWJM, van der Weijden T, Muris JWM. Interprofessional Pulmocheck care pathway: An innovative approach to managing pediatric asthma care in the Netherlands. J Asthma 2017; 55:779-784. [PMID: 29028376 DOI: 10.1080/02770903.2017.1363893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Under-diagnosis and suboptimal asthma control in children persists. An innovative care pathway was developed by a hospital department of pediatrics with the aim to detect pulmonary problems in children and provide appropriate treatment possibilities through systematic feedback towards the referring primary care physician. Primary care physicians can use this pathway to refer children with asthma-like symptoms for a one-day assessment. Goals are to measure the usage of the pathway by primary care general practitioners (GPs), the outcomes in terms of new diagnoses of asthma, the reduction in regular referrals, generated recommendations/therapy and the adequacy of asthma follow-up. METHODS We collected all feedback letters sent to the GP concerning children who underwent the Pulmocheck in 2010, 2011 and 2012. Furthermore, all GPs, who had referred a child to the Pulmocheck in this period and that subsequently was diagnosed with asthma and was further managed in primary care, were sent a follow-up questionnaire in 2014. RESULTS There were 121 referrals from 51 GPs in 3 years to this pathway. In 59.5% of these referrals a new diagnosis of asthma was established. In 90.9% one or more changes in clinical management were advised. The response rate to the follow-up questionnaires was 65.7% of which 4.8% of the children with new established asthma were reviewed four times or more in the follow-up period, 17.4% two times, 65.2% once, and in 8.7% were not followed. CONCLUSIONS The specialty pediatric asthma care pathway revealed a high number of children with newly diagnosed asthma, but was also helpful to exclude this diagnosis. However, the referral rate of GPs to this pathway was low, but in the children, that were referred several changes in the clinical management were advised and the frequency of monitoring of the children with diagnosed asthma was not in accordance with the asthma guidelines.
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Affiliation(s)
- J M J E Meuwissen
- a Department Family Medicine , Maastricht University , Maastricht , The Netherlands
| | - J Heynens
- b Department Pediatrics , Zuyderland Medical Centre , Sittard , The Netherlands
| | - T Dauven
- b Department Pediatrics , Zuyderland Medical Centre , Sittard , The Netherlands
| | - L Crasborn
- c Medical Coordinating Centre Omnes , Sittard , The Netherlands
| | - F W J M Smeenk
- d Department of Pulmonology , Catharina Hospital , Eindhoven , The Netherlands
| | - T van der Weijden
- e Department of General Practice , Maastricht University , MD Maastricht
| | - J W M Muris
- a Department Family Medicine , Maastricht University , Maastricht , The Netherlands
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Elias SG, Kok L, Witteman BJM, Goedhard JG, Romberg-Camps MJL, Muris JWM, de Wit NJ, Moons KGM. Published diagnostic models safely excluded colorectal cancer in an independent primary care validation study. J Clin Epidemiol 2016; 82:149-157.e8. [PMID: 27989951 DOI: 10.1016/j.jclinepi.2016.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/27/2016] [Accepted: 09/06/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To validate published diagnostic models for their ability to safely reduce unnecessary endoscopy referrals in primary care patients suspected of significant colorectal disease. STUDY DESIGN AND SETTING Following a systematic literature search, we independently validated the identified diagnostic models in a cross-sectional study of 810 Dutch primary care patients with persistent lower abdominal complaints referred for endoscopy. We estimated diagnostic accuracy measures for colorectal cancer (N = 37) and significant colorectal disease (N = 141; including colorectal cancer, inflammatory bowel disease, diverticulitis, or >1-cm adenomas). RESULTS We evaluated 18 models-12 specific for colorectal cancer-, of which most were able to safely rule out colorectal cancer: the best model (National Institute for Health and Care Excellence-1) prevented 59% of referrals (95% confidence interval [CI]: 56-63%), with 96% sensitivity (95% CI: 83-100%), 100% negative predictive value (NPV; 95% CI: 99-100%), and an area under the receiver operating characteristics curve (AUC) of 0.86 (95% CI: 0.80-0.92). The models performed less for significant colorectal disease: the best model (Brazer) prevented 23% of referrals (95% CI: 20-26%), with 95% sensitivity (95% CI: 90-98%), 96% NPV (95% CI: 92-98%), and an AUC of 0.73 (95% CI: 0.69-0.78). CONCLUSION Most models safely excluded colorectal cancer in many primary care patients with lower gastrointestinal complaints referred for endoscopy. Models performed less well for significant colorectal disease.
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Affiliation(s)
- Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, Utrecht, GA 3508, The Netherlands.
| | - Liselotte Kok
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, Utrecht, GA 3508, The Netherlands
| | - Ben J M Witteman
- Department of Gastroenterology, Gelderse Vallei Hospital, PO Box 9025, Ede, HN 6710, The Netherlands
| | - Jelle G Goedhard
- Department of Gastroenterology, Atrium Medical Center, PO Box 4446, Heerlen, CX 6401, The Netherlands
| | - Mariëlle J L Romberg-Camps
- Department of Gastroenterology, Orbis Medical Center, PO Box 5500, Sittard-Geleen, MB 6130, The Netherlands
| | - Jean W M Muris
- Department of General Practice, Care and Public Health Research Institute (Caphri), Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, Utrecht, GA 3508, The Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, Utrecht, GA 3508, The Netherlands
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Elias SG, Kok L, de Wit NJ, Witteman BJM, Goedhard JG, Romberg-Camps MJL, Muris JWM, Moons KGM. Is there an added value of faecal calprotectin and haemoglobin in the diagnostic work-up for primary care patients suspected of significant colorectal disease? A cross-sectional diagnostic study. BMC Med 2016; 14:141. [PMID: 27666114 PMCID: PMC5036273 DOI: 10.1186/s12916-016-0684-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/31/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The majority of primary care patients referred for bowel endoscopy do not have significant colorectal disease (SCD), and are - in hindsight - unnecessarily exposed to a small but realistic risk of severe endoscopy-associated complications. We developed a diagnostic strategy to better exclude SCD in these patients and evaluated the value of adding a faecal calprotectin point-of-care (POC) and/or a POC faecal immunochemical test for haemoglobin (FIT) to routine clinical information. METHODS We used data from a prospective diagnostic study in SCD-suspected patients from 266 Dutch primary care practices referred for endoscopy to develop a diagnostic model for SCD with routine clinical information, which we extended with faecal calprotectin POC (quantitatively in μg/g faeces) and/or POC FIT results (qualitatively with a 6 μg/g faeces detection limit). We defined SCD as colorectal cancer (CRC), inflammatory bowel disease, diverticulitis, or advanced adenoma (>1 cm). RESULTS Of 810 patients, 141 (17.4 %) had SCD. A diagnostic model with routine clinical data discriminated between patients with and without SCD with an area under the receiver operating characteristic curve (AUC) of 0.741 (95 % CI, 0.694-0.789). This AUC increased to 0.763 (95 % CI, 0.718-0.809; P = 0.078) when adding the calprotectin POC test, to 0.831 (95 % CI, 0.791-0.872; P < 0.001) when adding the POC FIT, and to 0.837 (95 % CI, 0.798-0.876; P < 0.001) upon combined extension. At a ≥ 5.0 % SCD probability threshold for endoscopy referral, 30.4 % of the patients tested negative based on this combined POC-tests extended model (95 % CI, 25.7-35.3 %), with 96.4 % negative predictive value (95 % CI, 93.1-98.2 %) and 93.7 % sensitivity (95 % CI, 88.2-96.8 %). Excluding the calprotectin POC test from this model still yielded 30.1 % test negatives (95 % CI, 24.7-35.6 %) and 96.0 % negative predictive value (95 % CI, 92.6-97.9 %), with 93.0 % sensitivity (95 % CI, 87.4-96.4 %). CONCLUSIONS FIT - and to a much lesser extent calprotectin - POC testing showed incremental value for SCD diagnosis beyond standard clinical information. A diagnostic strategy with routine clinical data and a POC FIT test may safely rule out SCD and prevent unnecessary endoscopy referral in approximately one third of SCD-suspected primary care patients. Please see related article: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0694-3 .
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Affiliation(s)
- Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Liselotte Kok
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Ben J M Witteman
- Department of Gastroenterology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Jelle G Goedhard
- Department of Gastroenterology, Atrium Medical Center, Heerlen, The Netherlands
| | | | - Jean W M Muris
- The Department of Family Medicine, Care and Public Health Research Institute (Caphri), Maastricht University, Maastricht, The Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
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Smid DE, Spruit MA, Houben-Wilke S, Muris JWM, Rohde GGU, Wouters EFM, Franssen FME. Burden of COPD in patients treated in different care settings in the Netherlands. Respir Med 2016; 118:76-83. [PMID: 27578474 DOI: 10.1016/j.rmed.2016.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/22/2016] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Care for patients with chronic obstructive pulmonary disease (COPD) can be provided in primary, secondary or tertiary care. Whether and to what extent patients with COPD treated in various healthcare settings differ in disease burden and healthcare utilization remains unknown. Therefore, daily symptoms, functional mobility, mood status, health status and healthcare utilization were compared between COPD patients in various care settings, to explore possibilities for healthcare-optimization. METHODS Current data are part of the Chance study. Demographics, functional mobility (Care Dependency Scale (CDS); Timed-Up-and-Go (TUG) test), mood status (Hospital Anxiety and Depression scale (HADS)), health status (COPD Assessment test (CAT); Clinical COPD questionnaire (CCQ); COPD specific St. George Respiratory questionnaire (SGRQ-C)), received treatments and severity of physical and psychological symptoms were assessed in subjects with and without COPD. RESULTS 836 subjects (100 primary care patients, 100 secondary care patients, 518 tertiary care patients and 118 non-COPD subjects) were included. The burden of disease significantly increased from primary care to tertiary care. However, in all three healthcare settings a high percentage of patients with an impaired health status was observed (i.e. CAT ≥10 points, 68.0% vs. 91.0% vs. 94.5%, respectively). Furthermore, many patients treated in secondary care remain highly symptomatic despite treatment, while others with low burden of disease would allow for de-intensification of care. CONCLUSION This study revealed important shortcomings and challenges for the care of COPD patients in the Netherlands. It emphasizes the need for detailed patient characterization and more individualized treatment, independent of the healthcare setting.
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Affiliation(s)
- Dionne E Smid
- Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands.
| | - Martijn A Spruit
- Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands
| | - Sarah Houben-Wilke
- Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands
| | - Jean W M Muris
- Caphri School of Public Health and Primary Care, Department of Family Medicine, P.O. Box 616, 6200 MD, Maastricht University, Maastricht, The Netherlands
| | - Gernot G U Rohde
- Department of Respiratory Medicine, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Emiel F M Wouters
- Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Frits M E Franssen
- Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Van Vliet D, Smolinska A, Jöbsis Q, Rosias PPR, Muris JWM, Dallinga JW, van Schooten FJ, Dompeling E. Association between exhaled inflammatory markers and asthma control in children. J Breath Res 2016; 10:016014. [PMID: 26893372 DOI: 10.1088/1752-7155/10/1/016014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The relationship between exhaled inflammatory markers and asthma control in children is unclear. To explore the association between inflammatory markers in exhaled breath (fractional nitric oxide (FeNO), volatile organic compounds (VOCs), cytokines/chemokines) and asthma control. To assess whether exhaled inflammatory markers are able to discriminate between children with persistently controlled/uncontrolled asthma. 96 asthmatic children were followed-up in a one-year observational study. Every 2 months, the following parameters were assessed: asthma control, FeNO, lung function (forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), exhaled VOCs, and cytokines/chemokines in exhaled breath condensate (EBC). Random Forest was used to analyse the relationship between exhaled inflammatory markers and asthma control. For each model, patients were randomly selected for a training set and validation set. To assess the accuracy of the classification models, receiver operating characteristic-curves (ROC-curves) were generated. No significant association was found between the exhaled inflammatory markers (FeNO, markers in EBC, VOCs) and asthma control (area under the ROC-curve 49%). However, 15 exhaled VOCs could discriminate between subgroups of children with persistently controlled and uncontrolled asthma during all clinical visits (area under the ROC-curve 86%). Adding FeNO and markers in EBC to this model, did not lead to a more accurate classification (area under the ROC-curve 87%). There was no association between exhaled inflammatory markers and asthma control in children. However, children with persistently controlled or uncontrolled asthma during the 12 month study period could be discriminated by a set of VOCs.
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Affiliation(s)
- D Van Vliet
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. Co-first authors
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Smid DE, Wilke S, Jones PW, Muris JWM, Wouters EFM, Franssen FME, Spruit MA. Impact of cardiovascular comorbidities on COPD Assessment Test (CAT) and its responsiveness to pulmonary rehabilitation in patients with moderate to very severe COPD: protocol of the Chance study. BMJ Open 2015; 5:e007536. [PMID: 26198426 PMCID: PMC4513521 DOI: 10.1136/bmjopen-2014-007536] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Patients with COPD are characterised by a reduced health status, which can be easily assessed by the COPD Assessment Test (CAT). Previous studies show that health status can be worsened by the presence of comorbidities. However, the impact of cardiovascular comorbidities on health status as assessed with CAT is not sufficiently investigated. Therefore, the current study has the following objectives: (1) to study the clinical, (patho)physiological and psychosocial determinants of the CAT, and impact of previously established and/or newly diagnosed cardiovascular comorbidities on health status in tertiary care patients with COPD; (2) to assess the effects of pulmonary rehabilitation on CAT scores in patients with COPD; (3) to develop reference values for the CAT in Dutch elderly patients without COPD; and (4) to validate the CAT in a broad sample of Dutch patients with COPD. METHODS AND ANALYSIS The COPD, Health status and Comorbidities (Chance) study is a monocentre study consisting of an observational cross-sectional part and a longitudinal part. Demographic and clinical characteristics will be assessed in primary care, secondary care and tertiary care patients with COPD, and in patients without COPD. To assess health status, the CAT, Clinical COPD Questionnaire (CCQ) and St George's Respiratory Questionnaire (SGRQ) will be used. The longitudinal part consists of a comprehensive pulmonary rehabilitation programme in 500 tertiary care patients. For the cross-sectional part of the study, 150 patients without COPD, 100 primary care patients and 100 secondary care patients will be assessed during a single home visit. ETHICS AND DISSEMINATION The Medical Ethical Committee of the Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands (METC 11-3-070), has approved this study. The study has been registered at the Dutch Trial Register (NTR 3416).
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Affiliation(s)
- Dionne E Smid
- Department of Research & Education, CIRO, Horn, The Netherlands
| | - Sarah Wilke
- Department of Research & Education, CIRO, Horn, The Netherlands
| | - Paul W Jones
- Division of Clinical Science, St George's University of London, London, UK
| | - Jean W M Muris
- Department of Family Medicine, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Emiel F M Wouters
- Department of Research & Education, CIRO, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frits M E Franssen
- Department of Research & Education, CIRO, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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Hungin APS, Becher A, Cayley B, Heidelbaugh JJ, Muris JWM, Rubin G, Seifert B, Russell A, De Wit NJ. Irritable bowel syndrome: an integrated explanatory model for clinical practice. Neurogastroenterol Motil 2015; 27:750-63. [PMID: 25703486 DOI: 10.1111/nmo.12524] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 01/13/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although irritable bowel syndrome (IBS) is a symptom-based diagnosis, clinicians' management of and communication about the disorder is often hampered by an unclear conceptual understanding of the nature of the problem. We aimed to elucidate an integrated explanatory model (EM) for IBS from the existing literature for pragmatic use in the clinical setting. METHODS Systematic and exploratory literature searches were performed in PubMed to identify publications on IBS and EMs. KEY RESULTS The searches did not identify a single, integrated EM for IBS. However, three main hypotheses were elucidated that could provide components with which to develop an IBS EM: (i) altered peripheral regulation of gut function (including sensory and secretory mechanisms); (ii) altered brain-gut signaling (including visceral hypersensitivity); and (iii) psychological distress. Genetic polymorphisms and epigenetic changes may, to some degree, underlie the etiology and pathophysiology of IBS and could increase the susceptibility to developing the disorder. The three model components also fit into one integrated explanation for abdominal symptoms and changes in stool habit. Additionally, IBS may share a common pathophysiological mechanism with other associated functional syndromes. CONCLUSIONS & INFERENCES It was possible to elucidate an integrated, three-component EM as a basis for clinicians to conceptualize the nature of IBS, with the potential to contribute to better diagnosis and management, and dialog with sufferers.
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Affiliation(s)
- A P S Hungin
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
| | - A Becher
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.,Research and Evaluation Unit, Oxford PharmaGenesis Ltd, Oxford, UK
| | - B Cayley
- Department of Family Medicine, University of Wisconsin, Madison, WI, USA
| | - J J Heidelbaugh
- Departments of Family Medicine and Urology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - J W M Muris
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - G Rubin
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
| | - B Seifert
- Institute of General Practice, Charles University, Praha, Czech Republic
| | - A Russell
- Department of Anthropology, Durham University, Durham, UK
| | - N J De Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Stanczyk NE, Smit ES, Schulz DN, de Vries H, Bolman C, Muris JWM, Evers SMAA. An economic evaluation of a video- and text-based computer-tailored intervention for smoking cessation: a cost-effectiveness and cost-utility analysis of a randomized controlled trial. PLoS One 2014; 9:e110117. [PMID: 25310007 PMCID: PMC4195710 DOI: 10.1371/journal.pone.0110117] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 09/14/2014] [Indexed: 11/19/2022] Open
Abstract
Background Although evidence exists for the effectiveness of web-based smoking cessation interventions, information about the cost-effectiveness of these interventions is limited. Objective The study investigated the cost-effectiveness and cost-utility of two web-based computer-tailored (CT) smoking cessation interventions (video- vs. text-based CT) compared to a control condition that received general text-based advice. Methods In a randomized controlled trial, respondents were allocated to the video-based condition (N = 670), the text-based condition (N = 708) or the control condition (N = 721). Societal costs, smoking status, and quality-adjusted life years (QALYs; EQ-5D-3L) were assessed at baseline, six-and twelve-month follow-up. The incremental costs per abstinent respondent and per QALYs gained were calculated. To account for uncertainty, bootstrapping techniques and sensitivity analyses were carried out. Results No significant differences were found in the three conditions regarding demographics, baseline values of outcomes and societal costs over the three months prior to baseline. Analyses using prolonged abstinence as outcome measure indicated that from a willingness to pay of €1,500, the video-based intervention was likely to be the most cost-effective treatment, whereas from a willingness to pay of €50,400, the text-based intervention was likely to be the most cost-effective. With regard to cost-utilities, when quality of life was used as outcome measure, the control condition had the highest probability of being the most preferable treatment. Sensitivity analyses yielded comparable results. Conclusion The video-based CT smoking cessation intervention was the most cost-effective treatment for smoking abstinence after twelve months, varying the willingness to pay per abstinent respondent from €0 up to €80,000. With regard to cost-utility, the control condition seemed to be the most preferable treatment. Probably, more time will be required to assess changes in quality of life. Future studies with longer follow-up periods are needed to investigate whether cost-utility results regarding quality of life may change in the long run. Trial Registration Nederlands Trial Register NTR3102
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Affiliation(s)
- Nicola E. Stanczyk
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
- * E-mail:
| | - Eline S. Smit
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Daniela N. Schulz
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Catherine Bolman
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands
| | - Jean W. M. Muris
- Department of Family Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Silvia M. A. A. Evers
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
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Wilke S, Smid DE, Spruit MA, Janssen DJA, Muris JWM, van der Molen T, van den Akker M, Jones PW, Wouters EFM, Franssen FME. The 2014 Updated GOLD Strategy: A Comparison of the Various Scenarios. Chronic Obstr Pulm Dis 2014; 1:212-220. [PMID: 28848823 DOI: 10.15326/jcopdf.1.2.2014.0135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: The 2014 updated Global initiative for chronic Obstructive Lung Disease (GOLD) strategy added the St. George's Respiratory Questionnaire (SGRQ) as the fourth possible symptoms measure. The impact of the suggested tools for symptoms of COPD and the different definitions of future risk on the frequency distribution and clinical characteristics of the GOLD groups remain unknown. Methods: Demographic and clinical characteristics were assessed in 542 patients with COPD (57.7% male, age 64.6 [9.0] years, FEV1 54.7 [22.3]% predicted). Health status was assessed by the COPD-specific SGRQ and symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale, anxiety (HADS-A) and depression (HADS-D) subscale. Cohen's Kappa was used to assess agreement between groups. Results: Level of agreement in frequency distribution using the modified Medical Research Council dyspnea (mMRC) scale ≥2, COPD Assessment Test (CAT) ≥10, Clinical COPD Questionnaire (CCQ) ≥1 and SGRQ ≥25 was moderate to very good. Best agreement was reached between CCQ and SGRQ (К = 0.838 or 0.851, p<0.001). Patients classified in mMRC GOLD A reported higher SGRQ scores, higher HADS-A and HADS-D scores compared to patients classified in CAT GOLD A or SGRQ GOLD A. Outcomes were comparable between the risk assessment groups. Conclusions: Choice of the symptom measure impacts GOLD groups more than choice of the exacerbation risk assessment. Health care professionals should be aware that patients are heterogeneous in terms of health status and symptoms of anxiety and depression based on the symptom measure used.
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Affiliation(s)
- Sarah Wilke
- Joint first author.,Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Dionne E Smid
- Joint first author.,Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Martijn A Spruit
- Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Daisy J A Janssen
- Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.,Centre of Expertise for Palliative Care, Maastricht University Medical Centre, the Netherlands
| | - Jean W M Muris
- Caphri School of Public Health and Primary Care, Department of Family Medicine, Maastricht University, the Netherlands
| | - Thys van der Molen
- Department of General Practice, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Marjan van den Akker
- Caphri School of Public Health and Primary Care, Department of Family Medicine, Maastricht University, the Netherlands.,Department of General Practice, KU Leuven, Leuven, Belgium
| | - Paul W Jones
- Division of Clinical Science, St. George's University of London, United Kingdom
| | - Emiel F M Wouters
- Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, the Netherlands
| | - Frits M E Franssen
- Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
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Fastenau A, Muris JWM, de Bie RA, Hendriks EJM, Asijee GM, Beekman E, Gosselink R, van Schayck OCP. Efficacy of a physical exercise training programme COPD in primary care: study protocol of a randomized controlled trial. BMC Public Health 2014; 14:788. [PMID: 25086593 PMCID: PMC4246559 DOI: 10.1186/1471-2458-14-788] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 07/23/2014] [Indexed: 01/12/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is recognized as a systemic illness with significant extra-pulmonary features, such as exercise intolerance and muscle weakness. Pulmonary rehabilitation has been shown to be very effective in counteracting these consequences in patients with more advanced COPD. However, limited data is available on the efficacy of a physical exercise training programme in patients with mild to moderate COPD in primary care. Furthermore, it is unknown if improved exercise capacity translates into enhanced daily physical activities. The aim of this paper is to describe the design of a randomized controlled trial to assess the efficacy of a physical exercise training programme in patients with mild to moderate COPD. Methods/design In this randomized controlled trial situated in the primary care setting, 102 patients with mild to moderate airflow obstruction (FEV1 ≥ 50% of predicted), dyspnoea and a physically inactive lifestyle will be randomized to an intervention or control group. The intervention group receives a 4-month physical exercise training programme at a local physiotherapy practice, which includes exercise training, resistance training, breathing exercises and advises on how to increase the level of physical activity. The control group receives usual care, i.e. advises on how to increase the level of physical activity and a sham treatment at a local physiotherapy practice of which no physiological training stimulus can be expected. Primary outcome is functional exercise capacity at 4-months measured on the six-minute walk distance. Secondary outcomes include peripheral muscle strength, physical activity in daily life, health related quality of life, Medical Research Council (MRC) dyspnoea score and patients’ perceived effectiveness. Follow-up measurement will take place at 6 months after baseline. Discussion This will be one of the first studies to evaluate the efficacy of a physical exercise training programme in patients with mild to moderate COPD completely recruited and assessed in primary care. The results of this trial may give a unique insight into the potential of the implementation of an easy, close-to-home rehabilitation programme. Trial registration The Netherlands National Trial Register NTR1471.
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Affiliation(s)
- Annemieke Fastenau
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Fastenau A, van Schayck OCP, Gosselink R, Aretz KCPM, Muris JWM. Discrepancy between functional exercise capacity and daily physical activity: a cross-sectional study in patients with mild to moderate COPD. Prim Care Respir J 2014; 22:425-30. [PMID: 24217860 PMCID: PMC6442859 DOI: 10.4104/pcrj.2013.00090] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: In patients with moderate to severe chronic obstructive pulmonary disease (COPD) the six-minute walk distance reflects the functional exercise level for daily physical activity. It is unknown if this also applies to patients with mild to moderate COPD in primary care. Aims: To assess the relationship between functional exercise capacity and physical activity in patients with mild to moderate COPD. Methods: A cross-sectional study was performed in 51 patients with mild to moderate COPD in primary care. Functional exercise capacity was assessed by the six-minute walk test and physical activity was measured with an accelerometer-based activity monitor. Results: Functional exercise capacity was close to normal values. However, the daily physical activity of the patients could be classified as ‘sedentary’ and ‘low active’. No significant correlations were observed between six-minute walk distance (% predicted) and any of the physical activity variables (steps per day, movement intensity during walking, total active time, total walking time, physical activity level, and time spent in moderate physical activity). Conclusions: A discrepancy was found between functional exercise capacity and daily physical activity in patients with mild to moderate COPD recruited and assessed in primary care. We conclude that these variables represent two different concepts. Our results reinforce the importance of measuring daily physical activity in order to fine-tune treatment (i.e. focusing on enhancement of exercise capacity or behavioural change, or both).
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Affiliation(s)
- Annemieke Fastenau
- Maastricht University Medical Centre, Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
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Hutchinson SG, Kuijlaars JS, Mesters I, Muris JWM, van Schayck CP, Dompeling E, Feron FJM. Addressing passive smoking in children. PLoS One 2014; 9:e93220. [PMID: 24809443 PMCID: PMC4014468 DOI: 10.1371/journal.pone.0093220] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 03/04/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A significant number of parents are unaware or unconvinced of the health consequences of passive smoking (PS) in children. Physicians could increase parental awareness by giving personal advice. AIM To evaluate the current practices of three Dutch health professions (paediatricians, youth health care physicians, and family physicians) regarding parental counselling for passive smoking (PS) in children. METHODS All physicians (n = 720) representing the three health professions in Limburg, The Netherlands, received an invitation to complete a self-administered electronic questionnaire including questions on their: sex, work experience, personal smoking habits, counselling practices and education regarding PS in children. RESULTS The response rate was 34%. One tenth (11%) of the responding physicians always addressed PS in children, 32% often, 54% occasionally and 4% reported to never attend to it. The three health professions appeared comparable regarding their frequency of parental counselling for PS in children. Addressing PS was more likely when children had respiratory problems. Lack of time was the most frequently mentioned barrier, being very and somewhat applicable for respectively 14% and 43% of the physicians. One fourth of the responders had received postgraduate education about PS. Additionally, 49% of the responders who did not have any education about PS were interested in receiving it. CONCLUSIONS Physicians working in the paediatric field in Limburg, The Netherlands, could more frequently address PS in children with parents. Lack of time appeared to be the most mentioned barrier and physicians were more likely to counsel parents for PS in children with respiratory complaints/diseases. Finally, a need for more education on parental counselling for PS was expressed.
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Affiliation(s)
- Sasha G. Hutchinson
- Department of Paediatric Pulmonology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
- * E-mail:
| | - Jennifer S. Kuijlaars
- Department of Paediatric Pulmonology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Ilse Mesters
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jean W. M. Muris
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Constant P. van Schayck
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Edward Dompeling
- Department of Paediatric Pulmonology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Frans J. M. Feron
- Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
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