Showing papers by "Geert-Jan Dinant published in 2017"

Frequency of chest pain in primary care, diagnostic tests performed and final diagnoses

Abstract: Objective Observational study of patients with chest pain in primary care: determination of incidence, referral rate, diagnostic tests and (agreement between) working and final diagnoses. Methods 118 general practitioners (GPs) in the Netherlands and Belgium recorded all patient contacts during 2weeks. Furthermore, patients presenting with chest pain were registered extensively. A follow-up form was filled in after 30 days. Results 22 294 patient contacts were registered. In 281 (1.26%), chest pain was a reason for consulting the GP (mean age for men 54.4/women 53 years). In this cohort of 281 patients, in 38.1% of patients, acute coronary syndrome (ACS) was suspected at least temporarily during consultation, 40.2% of patients were referred to secondary care and 512 diagnostic tests were performed by GPs and consulted specialists. Musculoskeletal pain was the most frequent working (26.1%) and final diagnoses (33.1%). Potentially life-threatening diseases as final diagnosis (such as myocardial infarction) accounted for 8.4% of all chest pain cases. In 23.1% of cases, a major difference between working and final diagnoses was found, in 0.7% a severe disease was initially missed by the GP. Conclusion Chest pain was present in 281 patients (1.26% of all consultations). Final diagnoses were mostly non-life-threatening. Nevertheless, in 8.4% of patients with chest pain, life-threatening underlying causes were identified. This seems reflected in the magnitude and wide variety of diagnostic tests performed in these patients by GPs and specialists, in the (safe) overestimation of life-threatening diseases by GPs at initial assessment and in the high referral rate we found.

Tuberculosis knowledge, attitudes, and practices among northern Ethiopian prisoners: Implications for TB control efforts.

Abstract: Introduction Although awareness is an important component in tuberculosis (TB) control, we do not know how much Ethiopian prisoners know about TB. This study assessed the level of knowledge, attitudes, and practices (KAP) of prisoners about TB in eight northern Ethiopian prisons. Methods Data were collected cross-sectionally from 615 prisoners using a standardized questionnaire between March and May 2016. The outcome variables were defined considering the basic elements about TB. Results Out of 615 prisoners, only 37.7% mentioned bacteria as a cause of TB while 21.7% related TB to exposure to cold wind. Eighty-eight per cent correctly mentioned the aerial route of TB transmission and 27.3% had perceived stigma towards TB. The majority (63.7%) was not aware of the possibility of getting multi-drug-resistant strains when they would not adhere to treatment. Overall, only 24% knew the basic elements about TB, 41% had favorable attitudes, and 55% had a good practice. Prisoners who were urban residents were generally more knowledgeable than rural residents (adjusted OR = 2.16; 95% CI = 1.15–4.06). Illiterates were found to be less knowledgeable (adjusted OR = 0.17; 95% CI = 0.06–0.46), less likely to have a favorable attitude (adjusted OR = 0.31; 95% CI = 0.15–0.64), and less good practice (adjusted OR = 0.35; 95% CI = 0.18–0.69). Significant differences were also observed between the different study prisons. Conclusions Knowledge of prisoners regarding the cause of TB and consequences of non-adherence to TB treatment was low. Knowledge on the transmission, symptoms, and prevention was fairly high. Health education interventions, focused on the cause and the translation of the knowledge to appropriate practices, are needed in all the study prisons. Special attention should be given to less educated prisoners, and to prisons with a high number of prisoners and those in remote areas.

The added value of C-reactive protein measurement in diagnosing pneumonia in primary care: a meta-analysis of individual patient data

Abstract: BACKGROUND: C-reactive protein (CRP) is increasingly being included in the diagnostic work-up for community-acquired pneumonia in primary care. Its added diagnostic value beyond signs and symptoms, however, remains unclear. We conducted a meta-analysis of individual patient data to quantify the added value of CRP measurement. METHODS: We included studies of the diagnostic accuracy of CRP in adult outpatients with suspected lower respiratory tract infection. We contacted authors of eligible studies for inclusion of data and for additional data as needed. The value of adding CRP measurement to a basic signs-and-symptoms prediction model was assessed. Outcome measures were improvement in discrimination between patients with and without pneumonia in primary care and improvement in risk classification, both within the individual studies and across studies. RESULTS: Authors of 8 eligible studies ( n = 5308) provided their data sets. In all of the data sets, discrimination between patients with and without pneumonia improved after CRP measurement was added to the prediction model (extended model), with a mean improvement in the area under the curve of 0.075 (range 0.02–0.18). In a hypothetical cohort of 1000 patients, the proportion of patients without pneumonia correctly classified at low risk increased from 28% to 36% in the extended model, and the proportion with pneumonia correctly classified at high risk increased from 63% to 70%. The number of patients with pneumonia classified at low risk did not change ( n = 4). Overall, the proportion of patients assigned to the intermediate-risk category decreased from 56% to 51%. INTERPRETATION: Adding CRP measurement to the diagnostic work-up for suspected pneumonia in primary care improved the discrimination and risk classification of patients. However, it still left a substantial group of patients classified at intermediate risk, in which clinical decision-making remains challenging.

Association between caregivers' knowledge and care seeking behaviour for children with symptoms of pneumonia in six sub-Saharan African Countries.

Abstract: Pneumonia is the main cause of child mortality world-wide and most of these deaths occur in sub-Saharan Africa (SSA). Treatment with effective antibiotics is crucial to prevent these deaths; nevertheless only 2 out of 5 children with symptoms of pneumonia are taken to an appropriate care provider in SSA. While various factors associated with care seeking have been identified, the relationship between caregivers’ knowledge of pneumonia symptoms and actual care seeking for their child with symptoms of pneumonia is not well researched. Based on data from Multiple Indicator Cluster Surveys, we assessed the association between caregivers’ knowledge of symptoms related to pneumonia – namely fast or difficulty breathing – and care seeking behaviour for these symptoms. We analysed data of 4,163 children with symptoms of pneumonia and their caregivers. A Chi-square tests and multivariable logistic regression was performed to assess the association between care seeking and knowledge of at least one symptom (i.e., fast or difficulty breathing). Across all 6 countries only around 30% of caregivers were aware of at least one of the two symptoms of pneumonia (i.e., fast or difficulty breathing). Our study shows that in the Democratic Republic of the Congo and Nigeria there was a positive association between knowledge and care seeking (P ≤ 0.01), even after adjusting for key variables (including wealth, residence, education). We found no association between caregivers’ knowledge of pneumonia symptoms and actual care seeking for their child with symptoms of pneumonia in Central African Republic, Chad, Malawi, and Sierra Leone. These findings reveal an urgent need to increase community awareness of pneumonia symptoms, while simultaneously designing context specific strategies to address the fundamental challenges associated with timely care seeking.

Does well-child care education improve consultations and medication management for childhood fever and common infections? A systematic review

Abstract: Fever is common in preschool children and is often caused by benign self-limiting infections. Parents' lack of knowledge and fever phobia leads to high healthcare consumption.To systematically review the effect of providing educational interventions about childhood fever and common infections in well-child clinics (WCCs), prior to illness episodes, on parental practices: healthcare-seeking behaviour (frequency of physician consultations, appropriateness of consultations) and medication management.Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science were searched. We included randomised controlled trials evaluating interventions in WCC settings focusing on educating parents prior to new illness episodes to improve parental practices during episodes of childhood fever and common infections. Data were extracted on study design, sample characteristics, type of intervention, outcome measures and results.Eight studies were eligible for data extraction. Educating parents, in WCCs, prior to new episodes of childhood fever and common infections reduces daytime physician consultations of parents, home visits and telephone consultations, and enhances medication management. However, single and multicomponent interventions vary in effectiveness in reducing the frequency of daytime physician consultations and differ in their potential to reduce the number of home visits and general practitioner out-of-hours contacts. Only multicomponent interventions achieved a reduction in telephone consultations and improved medication management.Educating parents in WCCs prior to episodes of childhood fever and common infections showed potential to improve parental practices in terms of healthcare-seeking behaviour and medication management.

The Perception and Needs of Psychologists Toward Blended Care.

Abstract: Background: Blended care, meaning that online (Internet) components are used in combination with face-to-face contact, in mental health is increasingly encouraged, but research about the needs of psychologists is scarce Methods: We assessed the perceptions, design, and barriers toward blended care among members of the Dutch Association of Psychologists through an e-mailed survey Mean scores (SD) and answer percentages were calculated Mann–Whitney tests were performed to investigate differences between users and nonusers and primary- and secondary care professionals Results: Generally, psychologists (63% response rate) had a positive perception toward blended care and they intended to use it in future (M = 371, SD = 119) Users of blended care and secondary care professionals were more positive toward blended care than nonusers and primary care professionals Online psychoeducation, diary forms, and exercises for different therapeutic approaches and communication technology configurations we

How do patients with chest pain access Emergency Department care

Abstract: BackgroundIt is important that patients with symptoms of acute coronary syndrome receive appropriate medical care as soon as possible. Little is known about the preadmission actions that patients with chest pain take before arrival at the Emergency Department (ED).ObjectiveThis study aimed to descri

COGITA network has constructed a glossary of diagnostic reasoning terms.

Abstract: The role of gut feelings in diagnostic reasoning is recognized by most GPs throughout Europe, and probably throughout the world. Studies on this topic have emerged from different countries but there is the risk that authors will use different terms for similar concepts. The European Expert Group on Cognitive and Interactive Processes in Diagnosis and Management in General Practice, COGITA for short, was founded in 2008 to conduct cross-border research in the area of non-analytical diagnostic reasoning. Academic GPs, PhD students, psychologists, linguists and students meet once a year to share their experiences, exchange results and initiate new studies on the topic. A milestone in their research is this publication of a short glossary of diagnostic reasoning terms relating to the gut feelings research topic. It was constructed by the COGITA group members following a literature review, which aimed to define salient terms used in their publications. They described the terms, cross-reviewed the wordi...

Early health technology assessment of future clinical decision rule aided triage of patients presenting with acute chest pain in primary care

Abstract: The objective of the paper is to estimate the number of patients presenting with chest pain suspected of acute coronary syndrome (ACS) in primary care and to calculate possible cost effects of a future clinical decision rule (CDR) incorporating a point-of-care test (PoCT) as compared with current practice. The annual incidence of chest pain, referrals and ACS in primary care was estimated based on a literature review and on a Dutch and Belgian registration study. A health economic model was developed to calculate the potential impact of a future CDR on costs and effects (ie, correct referral decisions), in several scenarios with varying correct referral decisions. One-way, two-way, and probabilistic sensitivity analyses were performed to test robustness of the model outcome to changes in input parameters. Annually, over one million patient contacts in primary care in the Netherlands concern chest pain. Currently, referral of eventual ACS negative patients (false positives, FPs) is estimated to cost €1,448 per FP patient, with total annual cost exceeding 165 million Euros in the Netherlands. Based on ‘international data’, at least a 29% reduction in FPs is required for the addition of a PoCT as part of a CDR to become cost-saving, and an additional €16 per chest pain patient (ie, 16.4 million Euros annually in the Netherlands) is saved for every further 10% relative decrease in FPs. Sensitivity analyses revealed that the model outcome was robust to changes in model inputs, with costs outcomes mainly driven by costs of FPs and costs of PoCT. If PoCT-aided triage of patients with chest pain in primary care could improve exclusion of ACS, this CDR could lead to a considerable reduction in annual healthcare costs as compared with current practice.

Patients with psychological ICPC codes in primary care; a case-control study investigating the decade before presenting with problems.

Abstract: Background: Recognizing patients with psychological problems can be difficult for general practitioners (GPs). Use of information collected in electronic medical records (EMR) could facilitate recognition.Objectives: To assess relevant EMR parameters in the decade before patients present with psychological problems.Methods: Exploratory case-control study assessing EMR parameters of 58 228 patients recorded between 2013 and 2015 by 54 GPs. We compared EMR parameters recorded before 2014 of patients who presented with psychological problems in 2014 with those who did not.Results: In 2014, 2406 patients presented with psychological problems. Logistic regression analyses indicated that having registrations of the following statistically significant parameters increased the chances of presenting with psychological problems in 2014: prior administration of a depression severity questionnaire (odds ratio (OR): 3.3); fatigue/sleeping (OR: 1.6), neurological (OR: 1.5), rheumatic (OR: 1.5) and substance abu...

European General Practice Research Network (EGPRN): Abstracts from the EGPRN conference in Riga, Latvia, 11–14 May 2017. Theme: ‘Reducing the risk of chronic diseases in general practice/family medicine’

Abstract: European General Practice Research Network (EGPRN) Abstracts from the EGPRN conference in Riga, Latvia, 11–14 May 2017. Theme: ‘Reducing the risk of chronic diseases in general practice/family medicine’s from the EGPRN conference in Riga, Latvia, 11–14 May 2017. Theme: ‘Reducing the risk of chronic diseases in general practice/family medicine’ Introduction to the theme ‘Reducing the risk of chronic diseases in general practice/family medicine’ The primary cause of death in Europe is chronic disease. Cardiovascular disease and diabetes alongside chronic obstructive pulmonary disease and cancer are among the four main chronic diseases. Premature death is a major consideration when evaluating the impact of chronic diseases on a given population and is used as an indicator in the global monitoring framework. During the EGPRN spring conference in Riga, Latvia, oral and interactive posters were presented alternately. Papers on ‘Screening Programme,’ ‘Prevention of Non-communicable Diseases,’ ‘Life Style Behavioural Changes’ and ‘Personnel Resources (Burnout Syndrome)’ were discussed among an international audience of family doctors and general practitioners.

E-diagnostiek voor psychische stoornissen

Abstract: Dijksman I, Dinant GJ, Spigt M. E-diagnostiek voor psychische stoornissen. Huisarts Wet 2017;60(9):432-5. Ter ondersteuning van de huisarts is een e-diagnostieksysteem ontwikkeld voor het classificeren van een mogelijke DSM-IV-stoornis. Wij vergeleken de validiteit van het e-diagnostieksysteem door routinematig verzamelde uitslagen van 496 patienten van Limburgse huisartsenpraktijken te vergelijken met het oordeel van een psycholoog. De interbeoordelaarsbetrouwbaarheid van de vier psychologen werd bepaald aan de hand van honderd aselect geselecteerde dossiers uit een voorgaand onderzoek. We analyseerden de concurrente validiteit van het e-diagnostieksysteem door middel van sensitiviteit, specificiteit, positieve en negatieve voorspellende waarde en Cohens kappa. De interbeoordelaarsbetrouwbaarheid was voldoende tot goed. Het systeem kon diverse stoornissen correct herkennen, uitsluiten en voorspellen. Het kon de afwezigheid van een as-II-stoornis adequaat bepalen (sensitiviteit en specificiteit 75%) en het gaf het correcte adviezen voor het echelon van behandeling (sensitiviteit 85 tot 92%, specificiteit 96 tot 99%). Het systeem genereerde voor een aantal klinische stoornissen echter veel foutpositieve en foutnegatieve diagnoses en beoordeelde het algemeen functioneren (as V) minder goed. Het onderzochte e-diagnostieksysteem is in de huisartsenpraktijk een valide screeningsinstrument voor de meeste DSM-IV-classificaties. Het kan de huisarts ondersteunen bij diagnostiek en verwijzing, maar vanwege de kans op een foutpositief of foutnegatief resultaat kan het een klinisch oordeel niet vervangen. Een versie op basis van DSM-5 wordt momenteel gevalideerd.