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Search Results: 1 - 10 of 55895 matches for " Paul Van Royen "
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Clinical prediction rules combining signs, symptoms and epidemiological context to distinguish influenza from influenza-like illnesses in primary care: a cross sectional study
Barbara Michiels, Isabelle Thomas, Paul Van Royen, Samuel Coenen
BMC Family Practice , 2011, DOI: 10.1186/1471-2296-12-4
Abstract: During five consecutive winter periods (2002-2007) 138 sentinel general practitioners sampled (naso- and oropharyngeal swabs) 4597 patients with an influenza-like illness (ILI) and registered their symptoms and signs, general characteristics and contextual information. The samples were analysed by a DirectigenFlu-A&B and RT-PCR tests. 4584 records were useful for further analysis.Starting from the most relevant variables in a Generalized Estimating Equations (GEE) model, we calculated the area under the Receiver Operating Characteristic curve (ROC AUC), sensitivity, specificity and likelihood ratios for positive (LR+) and negative test results (LR-) of single and combined signs, symptoms and context taking into account pre-test and post-test odds.In total 52.6% (2409/4584) of the samples were positive for influenza virus: 64% (2066/3212) during and 25% (343/1372) pre/post an influenza epidemic. During and pre/post an influenza epidemic the LR+ of 'previous flu-like contacts', 'coughing', 'expectoration on the first day of illness' and 'body temperature above 37.8°C' is 3.35 (95%CI 2.67-4.03) and 1.34 (95%CI 0.97-1.72), respectively. During and pre/post an influenza epidemic the LR- of 'coughing' and 'a body temperature above 37.8°C' is 0.34 (95%CI 0.27-0.41) and 0.07 (95%CI 0.05-0.08), respectively.Ruling out influenza using clinical and contextual information is easier than ruling it in. Outside an influenza epidemic the absence of cough and fever (> 37,8°C) makes influenza 14 times less likely in ILI patients. During an epidemic the presence of 'previous flu-like contacts', cough, 'expectoration on the first day of illness' and fever (>37,8°C) increases the likelihood for influenza threefold. The additional diagnostic value of rapid point of care tests especially for confirming influenza still has to be established.Especially during an influenza pandemic prompt diagnosis of influenza is important for the individual patient and society as well. Diagnosing of influe
Antibiotics for coughing in general practice: a questionnaire study to quantify and condense the reasons for prescribing
Samuel Coenen, Barbara Michiels, Paul Van Royen, Jean-Claude Van der Auwera, Joke Denekens
BMC Family Practice , 2002, DOI: 10.1186/1471-2296-3-16
Abstract: A postal questionnaire based upon focus group findings was sent to 316 Flemish general practitioners (GPs). On a verbal rating scale the GPs scored to what extent they consider the questionnaire items in decision making in case of suspected RTI in a coughing patient and how strongly the items support or counter antibiotic treatment. Factor analysis was used to condense the data. The relative importance of the yielded operational factors was assessed using Wilcoxon Matched Pairs test.59.5% completed the study. Response group characteristics (mean age: 42.8 years; 65.9% men) approximated that of all Flemish GPs. Participants considered all the items included in the questionnaire: always the operational factor 'lung auscultation', often 'whether or not there is something unusual happening' – both medical reasons – and to a lesser extent 'non-medical reasons' (P < 0.001). Non-medical as well as medical reasons support antibiotic treatment, but non-medical reasons to a lesser extent (P < 0.001).This study quantified, condensed and confirmed the findings of previous focus group research. Practice guidelines and interventions to optimise antibiotic prescribing have to take non-medical reasons into account.Antibiotics are being overprescribed in ambulant care,[1] especially for respiratory tract infections (RTIs).[2] For this prescribing decision different types of determinants are already highlighted. [3-6] However, gaining insight into the actual reasons for context specific prescribing remains important to design effective strategies to optimise antibiotic prescribing.[7]In general practice, medical decisions (concerning RTIs) are prompted most often by complaints about coughing: 169 times per 1000 patients per year for a new illness episode.[8] Since there is no evidence base for the prescription of antibiotics for coughing in case of suspected RTI,[9] and since antibiotic prescribing results in financial costs to the patient and society, adverse effects and development
GPs' perspectives of type 2 diabetes patients' adherence to treatment: A qualitative analysis of barriers and solutions
Johan Wens, Etienne Vermeire, Paul Van Royen, Bernard Sabbe, Joke Denekens
BMC Family Practice , 2005, DOI: 10.1186/1471-2296-6-20
Abstract: In a descriptive qualitative study, we explored the thoughts and feelings of general practitioners (GPs) on patients' compliance/adherence. Forty interested GPs could be recruited for focus group participation. Five open ended questions were derived on the one hand from a similar qualitative study on compliance/adherence in patients living with type 2 diabetes and on the other hand from the results of a comprehensive review of recent literature on compliance/adherence. A well-trained diabetes nurse guided the GPs through the focus group sessions while an observer was attentive for non-verbal communication and interactions between participants. All focus groups were audio taped and transcribed for content analysis. Two researchers independently performed the initial coding. A first draft with results was sent to all participants for agreement on content and comprehensiveness.General practitioners experience problems with the patient's deficient knowledge and the fact they minimize the consequences of having and living with diabetes. It appears that great confidence in modern medical science does not stimulate many changes in life style. Doctors tend to be frustrated because their patients do not achieve the common Evidence Based Medicine (EBM) objectives, i.e. on health behavior and metabolic control. Relevant solutions, derived from qualitative studies, for better compliance/adherence seem to be communication, tailored and shared care. GPs felt that a structured consultation and follow-up in a multidisciplinary team might help to increase compliance/adherence. It was recognized that the GP's efforts do not always meet the patients' health expectations. This initiates GPs' frustration and leads to a paternalistic attitude, which may induce anxiety in the patient. GPs often assume that the best methods to increase compliance/adherence are shocking the patients, putting pressure on them and threatening to refer them to hospital.GPs identified a number of problems with
Out of hours care: a profile analysis of patients attending the emergency department and the general practitioner on call
Hilde Philips, Roy Remmen, Peter De Paepe, Walter Buylaert, Paul Van Royen
BMC Family Practice , 2010, DOI: 10.1186/1471-2296-11-88
Abstract: Data collection was conducted simultaneously in 4 large cities in Belgium. All patients who visited EDs or used the services of the GP on call during two weekends in January 2005 were enrolled in the study in a prospective manner. We used semi-structured questionnaires to interview patients from both services.1611 patient contacts were suitable for further analysis. 640 patients visited the GP and 971 went to the ED. Determinants that associated with the choice of the ED are: being male, having visited the ED during the past 12 months at least once, speaking another language than Dutch or French, being of African (sub-Saharan as well as North African) nationality and no medical insurance. We also found that young men are more likely to seek help at the ED for minor trauma, compared to women.Patients tend to seek help at the service they are acquainted with. Two populations that distinctively seek help at the ED for minor medical problems are people of foreign origin and men suffering minor trauma. Aiming at a redirection of patients, special attention should go to these patients. Informing them about the health services' specific tasks and the needlessness of technical examinations for minor trauma, might be a useful intervention.Overuse of emergency departments (ED) is of concern in Western society and it is often referred to as 'inappropriate' use [1-6]. Patients assess their medical problems with worries and interpretations in their own context and may decide to seek help independently from referral or triage systems [7,8]. Although there is some consensus of doctors and nurses concerning the perception of 'emergency', important differences were found between the perception of patients and clinical staff [9,10]. Patients' perceptions of an emergency do not necessarily correspond with clinical interpretations made by health care providers [11]. What is or is not an 'emergency' can lead to different interpretations of 'appropriate' and 'inappropriate use' of ED.Ina
Collecting data for sexually transmitted infections (STI) surveillance: what do patients prefer in Flanders?
Veronique Verhoeven, Annelies Colliers, Ann Verster, Dirk Avonts, Lieve Peremans, Paul Van Royen
BMC Health Services Research , 2007, DOI: 10.1186/1472-6963-7-149
Abstract: A questionnaire-based survey in a stratified population sample of 300 patients aged 18–60 years.The large majority of respondents stated to be willing to give information on their sexual practices for the purpose of STI surveillance. They preferred to answer sexual history questions to their GP; filling in a form on the internet was the second best option.Based on these results, it is unlikely that the cooperation of patients would be a weak link in STI surveillance strategies. This observation, together with the fact that the majority of patients at risk for STIs have regular access to general practice services, justify renewed efforts to enliven primary care-based STI surveillance strategies.Surveillance data are essential resources for understanding and controlling the increasing incidence of STIs in Europe [1].Belgium [2], as most other European countries [1], has several complementary STI surveillance systems in operation. Case reporting is mandatory for syphilis, gonorrhoea, hepatitis B/C and scabies. Furthermore, a voluntary sentinel laboratory system and a recently introduced sentinel case reporting system collect information on a larger number of STIs.The resulting databases are managed by different authorities and all systems contend with underreporting of cases as well as incomplete provision of data on case reports. Although laboratory data show that a substantial number of STI cases are detected by GPs, coverage of case reporting in primary care is very low.An earlier focus group study in general practice [3] unveiled that GPs have many barriers towards STI surveillance. In that study GPs were worried about embarrassing patients by asking sensitive questions, and they perceived patients to be reluctant to disclose information on their sexual lives to their doctors. This seems to be an important reason for GPs not to participate in STI surveillance.Patients' attitude towards data collection obviously is vital for the success of any surveillance system. H
What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care
Hilde Philips, Roy Remmen, Paul Van Royen, Marc Teblick, Leo Geudens, Marc Bronckaers, Herman Meeuwis
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-222
Abstract: We used a prospective before/after interventional study design. The intervention was the implementation of a GPC.One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836).One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.From the nineties, general practitioner cooperatives (GPC) were established in many European countries, as a new alternative for the organisation of out-of-hours medical care by general practitioners. Various models exist across health care models. Although we do not have a clear-cut definition of 'appropriate use' or, inappropriate use' of the ED, it has been argued that many medical problems presented at the ED could easily be managed in a primary care setting [1,2]. Many studies report overuse of the ED for primary care medical problems [3-11]. One objective therefore may be to redirect patients from seconda
Consensus on gut feelings in general practice
Erik Stolper, Paul Van Royen, Margje Van de Wiel, Marloes Van Bokhoven, Paul Houben, Trudy Van der Weijden, Geert Jan Dinant
BMC Family Practice , 2009, DOI: 10.1186/1471-2296-10-66
Abstract: Qualitative research including a Delphi consensus procedure with a heterogeneous sample of 27 Dutch and Belgian GPs or ex-GPs involved in academic educational or research programmes.After four rounds, we found 70% or greater agreement on seven of the eleven proposed statements. A "sense of alarm" is defined as an uneasy feeling perceived by a GP as he/she is concerned about a possible adverse outcome, even though specific indications are lacking: There's something wrong here. This activates the diagnostic process by stimulating the GP to formulate and weigh up working hypotheses that might involve a serious outcome. A "sense of alarm" means that, if possible, the GP needs to initiate specific management to prevent serious health problems. A "sense of reassurance" is defined as a secure feeling perceived by a GP about the further management and course of a patient's problem, even though the doctor may not be certain about the diagnosis: Everything fits in.The sense of alarm and the sense of reassurance are well-defined concepts. These descriptions enable us to operationalise the concept of gut feelings in further research.Uncertainty and unpredictability are common phenomena in general practice. [1] Unexplained complaints and ill-defined syndromes together form the group of uncertain diagnoses and uncertainty remains a characteristic part of medical life. [2-4] Although gut feelings can play a role in dealing with this diagnostic and prognostic uncertainty, [5-7] studies about the validity of gut feelings are lacking.A qualitative study using four focus groups of 28 GPs in the Netherlands distinguished two types of gut feelings: a sense of alarm and a sense of reassurance. [8] Gut feelings are based on the recognition of a pattern that agrees or disagrees with the expected pattern for an individual patient or for a clinical picture, sometimes without a specific diagnosis. Although GPs are not always aware of their sense of reassurance, a sense of alarm alerts GPs and
The diagnostic role of gut feelings in general practice A focus group study of the concept and its determinants
Erik Stolper, Marloes van Bokhoven, Paul Houben, Paul Van Royen, Margje van de Wiel, Trudy van der Weijden, Geert Jan Dinant
BMC Family Practice , 2009, DOI: 10.1186/1471-2296-10-17
Abstract: Qualitative research including 4 focus group discussions. A heterogeneous sample of 28 GPs. Text analysis of the focus group discussions, using a grounded theory approach.Gut feelings are familiar to most GPs in the Netherlands and play a substantial role in their everyday routine. The participants distinguished two types of gut feelings, a sense of reassurance and a sense of alarm. In the former case, a GP is sure about prognosis and therapy, although they may not always have a clear diagnosis in mind. A sense of alarm means that a GP has the feeling that something is wrong even though objective arguments are lacking. GPs in the focus groups experienced gut feelings as a compass in situations of uncertainty and the majority of GPs trusted this guide. We identified the main determinants of gut feelings: fitting, alerting and interfering factors, sensation, contextual knowledge, medical education, experience and personality.The role of gut feelings in general practice has become much clearer, but we need more research into the contributions of individual determinants and into the test properties of gut feelings to make the concept suitable for medical education.Most general practitioners (GPs) would recognise that feeling of sudden heightened awareness or alarm, which sometimes emerges during a consultation: "There's something wrong with this patient but I don't know exactly what. I have to do something because a delay can be harmful". It is a non-specific sense of alarm, which may perhaps seem difficult to explain rationally, an almost visceral sense that something serious may be wrong with the patient. Something vague in the patient's story or in the presentation triggers an alert. Sometimes GPs base their clinical decision on this gut feeling alone, even though there is little evidence of the diagnostic value of gut feelings in general practice. Hardly anything can be found about this phenomenon in the medical literature, which mainly focuses on problem-solving an
The effect of giving influenza vaccination to general practitioners: a controlled trial [NCT00221676]
Michiels Barbara, Philips Hilde, Coenen Samuel, Yane Fernande, Steinhauser Toon, Stuyck Sofie, Denekens Joke, Van Royen Paul
BMC Medicine , 2006, DOI: 10.1186/1741-7015-4-17
Abstract: In a controlled trial during two consecutive winter periods (2002–2003 and 2003–2004) we compared (77 and 100) vaccinated with (45 and 40) unvaccinated GPs working in Flanders, Belgium. Influenza antibodies were measured immediately prior to and 3–5 weeks after vaccination, as well as after the influenza epidemic. During the influenza epidemic, GPs had to record their contact with influenza cases and their own RTI symptoms every day. If they became ill, the GPs had to take nose and throat swabs during the first 4 days. We performed a multivariate regression analysis for covariates using Generalized Estimating Equations.One half of the GPs (vaccinated or not) developed an RTI during the 2 influenza epidemics. During the two influenza periods, 8.6% of the vaccinated and 14.7% of the unvaccinated GPs had positive swabs for influenza (RR: 0.59; 95%CI: 0.28 – 1.24). Multivariate analysis revealed that influenza vaccination prevented RTIs and swab-positive influenza only among young GPs (ORadj: 0.35; 95%CI: 0.13 – 0.96 and 0.1; 0.01 – 0.75 respectively for 30-year-old GPs). Independent of vaccination, a low basic antibody titre against influenza (ORadj 0.57; 95%CI: 0.37 – 0.89) and the presence of influenza cases in the family (ORadj 9.24; 95%CI: 2.91 – 29) were highly predictive of an episode of swab-positive influenza.Influenza vaccination was shown to protect against proven influenza among young GPs. GPs, vaccinated or not, who are very vulnerable to influenza are those who have a low basic immunity against influenza and, in particular, those who have family members who develop influenza.There are two important issues when considering influenza vaccination of general practitioners (GPs) as advocated by many guidelines. [1,2] Firstly, an influenza vaccine must give personal protection to the GP. To a certain extent, this issue has been addressed by efficacy studies among healthy adults. [3] Secondly, vaccination might be useful for preventing transmission of influenza b
Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study [ISRCTN28478651]
Ludeke C Lambeek, Johannes R Anema, Barend J van Royen, Peter C Buijs, Paul I Wuisman, Maurits W van Tulder, Willem van Mechelen
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-254
Abstract: The objective is to present the design of a randomized controlled trial, i.e. the BRIDGE-study, evaluating the effectiveness in improving RTW and cost-effectiveness of a multidisciplinary outpatient care program situated in both primary and outpatient care setting compared with usual clinical medical care for patients with chronic LBP.The design is a randomized controlled trial with an economic evaluation alongside. The study population consists of patients with chronic LBP who are completely or partially sick listed and visit an outpatient clinic of one of the participating hospitals in Amsterdam (the Netherlands). Two interventions will be compared. 1. a multidisciplinary outpatient care program consisting of a workplace intervention based on participatory ergonomics, and a graded activity program using cognitive behavioural principles. 2. usual care provided by the medical specialist, the occupational physician, the patient's general practitioner and allied health professionals. The primary outcome measure is sick leave duration until full RTW. Sick leave duration is measured monthly by self-report during one year. Data on sick leave during one-year follow-up are also requested form the employers. Secondary outcome measures are pain intensity, functional status, pain coping, patient satisfaction and quality of life. Outcome measures are assessed before randomization and 3, 6, and 12 months later. All statistical analysis will be performed according to the intension-to-treat principle.Usual care of primary and outpatient health services isn't directly aimed at RTW, therefor it is desirable to look for care which is aimed at RTW. Research shows that several occupational interventions in primary care are aimed at RTW. They have shown a significant reduction of sick leave for employee with LBP. If a comparable reduction of sick leave duration of patients with chronic LBP of who attend an outpatient clinic can be achieved, such reductions will be obviously substantial
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