Author
Jan H.B. Geertzen
Other affiliations: University of Groningen
Bio: Jan H.B. Geertzen is an academic researcher from University Medical Center Groningen. The author has contributed to research in topics: Amputation & Medicine. The author has an hindex of 18, co-authored 20 publications receiving 3304 citations. Previous affiliations of Jan H.B. Geertzen include University of Groningen.
Topics: Amputation, Medicine, Population, Phantom pain, Phantom limb
Papers
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TL;DR: There are many different potential barriers of which some are tied to ethnic minorities, and awareness about the myriad of potential barriers is raised so that the problem of barriers to health care for different ethnic minorities becomes transparent.
Abstract: BACKGROUND: Ethnic minority patients seem to be confronted with barriers when using health services. Yet, care providers are often oblivious to these barriers, although they may share to some extent the burden of responsibility for them. In order to enlighten care providers, as to the potential pitfalls that may exist, there is a need to explore the different factors in the creation of the barriers. OBJECTIVE: Therefore, the objective of this paper is to present an overview of the potential barriers and the factors, which may restrict ethnic minority patients from using health services, according to the literature available. METHODS: Articles published from 1990 to 2003 were identified by searching electronic databases and selected through titles and abstracts. The articles were included if deemed to be relevant to study health services use by ethnic minorities, i.e. the different factors in the creation of a barrier. RESULTS: There were 54 articles reviewed. They reported on studies carried out in different countries and among different ethnic minorities. Potential barriers occurred at three different levels: patient level, provider level and system level. The barriers at patient level were related to the patient characteristics: demographic variables, social structure variables, health beliefs and attitudes, personal enabling resources, community enabling resources, perceived illness and personal health practices. The barriers at provider level were related to the provider characteristics: skills and attitudes. The barriers at system level were related to the system characteristics: the organisation of the health care system. CONCLUSION: This review has the goal of raising awareness about the myriad of potential barriers, so that the problem of barriers to health care for different ethnic minorities becomes transparent. In conclusion, there are many different potential barriers of which some are tied to ethnic minorities. The barriers are all tied to the particular situation of the individual patient and subject to constant adjustment. In other words, generalizations should not be made.
687 citations
TL;DR: Prevalence and factors associated with phantom pain and phantom sensations in upper limb amputees in The Netherlands, and the relationship between phantom pain, phantom sensations and prosthesis use in higher limb Amputees was investigated were investigated.
Abstract: Phantom pain in subjects with an amputated limb is a well-known problem. However, estimates of the prevalence of phantom pain differ considerably in the literature. Various factors associated with phantom pain have been described including pain before the amputation, gender, dominance, and time elapsed since the amputation. The purposes of this study were to determine prevalence and factors associated with phantom pain and phantom sensations in upper limb amputees in The Netherlands. Additionally, the relationship between phantom pain, phantom sensations and prosthesis use in upper limb amputees was investigated. One hundred twenty-four upper limb amputees participated in this study. Subjects were asked to fill out a self-developed questionnaire scoring the following items: date, side, level, and reason of amputation, duration of experienced pain before amputation, frequencies with which phantom sensations, phantom pain, and stump pain are experienced, amount of trouble and suffering experienced, respectively, related to these sensations, type of phantom sensations, medical treatment received for phantom pain and/or stump pain, and the effects of the treatment, self medication, and prosthesis use. The response rate was 80%. The prevalence of phantom pain was 51%, of phantom sensations 76% and of stump pain 49%; 48% of the subjects experienced phantom pain a few times per day or more; 64% experienced moderate to very much suffering from the phantom pain. A significant association was found between phantom pain and phantom sensations (relative risk 11.3) and between phantom pain and stump pain (relative risk 1.9). No other factors associated with phantom pain or phantom sensations could be determined. Only four patients received medical treatment for their phantom pain. Phantom pain is a common problem in upper limb amputees that causes considerable suffering for the subjects involved. Only a minority of subjects are treated for phantom pain. Further research is needed to determine factors associated with phantom pain.
461 citations
TL;DR: It is concluded that further research is needed into each of the therapeutic modalities discussed in the guidelines for treatment of CRPS-I, because of the extent of evidence found for therapeutic interventions found.
Abstract: Treatment of complex regional pain syndrome type I (CRPS-I) is subject to discussion. The purpose of this study was to develop multidisciplinary guidelines for treatment of CRPS-I. A multidisciplinary task force graded literature evaluating treatment effects for CRPS-I according to their strength of evidence, published between 1980 to June 2005. Treatment recommendations based on the literature findings were formulated and formally approved by all Dutch professional associations involved in CRPS-I treatment. For pain treatment, the WHO analgesic ladder is advised with the exception of strong opioids. For neuropathic pain, anticonvulsants and tricyclic antidepressants may be considered. For inflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine) are advised. To promote peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used to increase blood flow in case vasodilatory medication has insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, vitamin C is recommended. Adequate perioperative analgesia, limitation of operating time, limited use of tourniquet, and use of regional anaesthetic techniques are recommended for secondary prevention of CRPS-I. Based on the literature identified and the extent of evidence found for therapeutic interventions for CRPS-I, we conclude that further research is needed into each of the therapeutic modalities discussed in the guidelines.
311 citations
TL;DR: Few studies investigated the relationship between late morbidity of the upper limb after treatment of early breast cancer and ADL/QOL, and the strength of this relationship was rather low.
Abstract: Aims: Breast cancer treatment may result in long-term upper limb morbidity: reduced range of motion of the shoulder, muscle weakness of the arm and hand, lymph edema, pain and numbness. Relationship of this late morbidity with activities of daily life (ADL) and quality of life (QOL) is infrequently described and the strength of this relationship is not clear. Methods: A systematic review was performed to evaluate the results of studies, analyzing late morbidity of breast cancer treatment in relationship with ADL and/or QOL. A literature search over the last 20 years (1980‐2000) was performed in the databases MEDLINE, EMBASE, PSYCHLIT and CANCERLIT. Methodological quality of selected articles was assessed and additional, aspects of treatment related late morbidity and the relationship to ADL and/or QOL were summarized. Results: From the 1642 yielded articles 15 fulfilled our primary selection criteria. Only six articles could be selected due to the inappropriate methodological quality. There was high variation in prevalence of pain (12‐51%), impairments in range of motion (2‐51%), edema (6‐43%) and decreased muscle strength (17‐33%). Four articles reported significant relationships between late morbidity of the upper limb and perceived disabilities in ADL/QOL. The strength of these relationships was rather low. Conclusions: Few studies investigated the relationship between late morbidity of the upper limb after treatment of early breast cancer and ADL/QOL. Significant relationship between late morbidity and restrictions of daily activities and poorer QOL was reported, however, the strength of this relationship was rather low. # 2002 Elsevier Science Ltd. All rights reserved.
241 citations
TL;DR: The purposes of this study were to describe health-related quality of life in a population of lower limb amputees and to investigate potential determinants, including phantom pain, including walking distance and stump pain.
207 citations
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TL;DR: Head-to-head clinical trials comparing NP therapies are needed to help assess the relative clinical efficacy of treatments, ideally using HR-QOL and utility outcomes, and to facilitate future cost-effectiveness research in NP.
Abstract: A number of different diseases or injuries can damage the central or peripheral nervous system and produce neuropathic pain (NP), which seems to be more difficult to treat than many other types of chronic pain. As a group, patients with NP have greater medical co-morbidity burden than age- and sex-adjusted controls, which makes determining the humanistic and economic burden attributable to NP challenging. Health-related quality of life (HR-QOL) is substantially impaired among patients with NP. Patients describe pain-related interference in multiple HR-QOL and functional domains, as well as reduced ability to work and reduced mobility due to their pain. In addition, the spouses of NP patients have been shown to experience adverse social consequences related to NP. In randomized controlled trials, several medications have been shown to improve various measures of HR-QOL. Changes in HR-QOL appear to be tightly linked to pain relief, but not to the development of adverse effects. However, in cross-sectional studies, many patients continue to have moderate or severe pain and markedly impaired HR-QOL, despite taking medications prescribed for NP. The quality of NP treatment appears to be poor, with few patients receiving recommended medications in efficacious dosages. The substantial costs to society of NP derive from direct medical costs, loss of the ability to work, loss of caregivers' ability to work and possibly greater need for institutionalization or other living assistance. No single study has measured all of these costs to society for chronic NP. The cost effectiveness of various interventions for the treatment or prevention of different types of NP has been assessed in several different studies. The most-studied diseases are post-herpetic neuralgia and painful diabetic neuropathy, for which tricyclic antidepressants (both amitriptyline and desipramine) have been found to be either cost effective or dominant relative to other strategies. Increasing the use of cost-effective therapies such as tricyclic antidepressants for post-herpetic neuralgia and painful diabetic neuropathy may improve the HR-QOL of patients and decrease societal costs. Head-to-head clinical trials comparing NP therapies are needed to help assess the relative clinical efficacy of treatments, ideally using HR-QOL and utility outcomes. The full costs to society of NP, including productivity loss costs, have not been determined for chronic NP. Improved relative efficacy, utility and cost estimates would facilitate future cost-effectiveness research in NP.
1,082 citations
TL;DR: Despite increased attention on assessment and management, pain continues to be a prevalent symptom in patients with cancer and in the upcoming decade, the authors need to overcome barriers toward effective pain treatment and develop and implement interventions to optimally manage pain in Patients with cancer.
1,059 citations
TL;DR: It is shown that changes in the microenvironment including alterations in mechanical forces, oxygen levels, chemokines, extracellular matrix and growth factor synthesis directly impact cellular recruitment and activation, leading to impaired states of wound healing.
Abstract: Wound healing is one of the most complex processes in the human body. It involves the spatial and temporal synchronization of a variety of cell types with distinct roles in the phases of hemostasis...
1,018 citations
University of California, San Francisco1, University of Birmingham2, University of Liège3, Advocate Lutheran General Hospital4, Kantonsspital St. Gallen5, University of Adelaide6, Baylor College of Medicine7, Mayo Clinic8, University of Southern California9, Asahikawa Medical University10, University of Dundee11, Pontifical Catholic University of Chile12, Uppsala University13, University of Hong Kong14, Royal Adelaide Hospital15, University of Hamburg16, Sunnybrook Health Sciences Centre17, University of Minnesota18, Technische Universität München19, University of Cambridge20, University of Bologna21, Washington University in St. Louis22, Greenville Health System23, University of Bristol24, University of Ottawa25, Nagoya University26, University of Texas Southwestern Medical Center27, Shanghai Jiao Tong University28, Icahn School of Medicine at Mount Sinai29, Brigham and Women's Hospital30, Oregon Health & Science University31, University of Buenos Aires32, Duke University33, St. Elizabeth's Medical Center34, Dartmouth College35, University of Massachusetts Amherst36, University of the Witwatersrand37, Ghent University Hospital38, Sun Yat-sen University39
TL;DR: The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP) resulting in three stages of complexity for intervention.
993 citations
TL;DR: There is a need for education of the medical profession and the general public, so that effective measures are introduced and unnecessary and inappropriate operations minimized, and severe acute postoperative pain emerges as a factor that may be able to influence.
Abstract: In the past ten years there has been recognition that chronic post-surgical pain is a significant problem. This is a complex area of research and although the quality of studies has improved many difficulties remain. Several recent publications have examined risk factors. Severe acute postoperative pain emerges as a factor that we may be able to influence. There is a need for education of the medical profession and the general public, so that effective measures are introduced and unnecessary and inappropriate operations minimized.
838 citations