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van den Brink MJ, Beelen P, Herman MC, Geomini PM, Dekker JH, Vermeulen KM, Bongers MY, Berger MY. The levonorgestrel intrauterine system versus endometrial ablation for heavy menstrual bleeding: a cost-effectiveness analysis. BJOG 2021; 128:2003-2011. [PMID: 34245652 PMCID: PMC8518490 DOI: 10.1111/1471-0528.16836] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
Objective To evaluate the costs and non‐inferiority of a strategy starting with the levonorgestrel intrauterine system (LNG‐IUS) compared with endometrial ablation (EA) in the treatment of heavy menstrual bleeding (HMB). Design Cost‐effectiveness analysis from a societal perspective alongside a multicentre randomised non‐inferiority trial. Setting General practices and gynaecology departments in the Netherlands. Population In all, 270 women with HMB, aged ≥34 years old, without intracavitary pathology or wish for a future child. Methods Randomisation to a strategy starting with the LNG‐IUS (n = 132) or EA (n = 138). The incremental cost‐effectiveness ratio was estimated. Main outcome measures Direct medical costs and (in)direct non‐medical costs were calculated. The primary outcome was menstrual blood loss after 24 months, measured with the mean Pictorial Blood Assessment Chart (PBAC)‐score (non‐inferiority margin 25 points). A secondary outcome was successful blood loss reduction (PBAC‐score ≤75 points). Results Total costs per patient were €2,285 in the LNG‐IUS strategy and €3,465 in the EA strategy (difference: €1,180). At 24 months, mean PBAC‐scores were 64.8 in the LNG‐IUS group (n = 115) and 14.2 in the EA group (n = 132); difference 50.5 points (95% CI 4.3–96.7). In the LNG‐IUS group, 87% of women had a PBAC‐score ≤75 points versus 94% in the EA group (relative risk [RR] 0.93, 95% CI 0.85–1.01). The ICER was €23 (95% CI €5–111) per PBAC‐point. Conclusions A strategy starting with the LNG‐IUS was cheaper than starting with EA, but non‐inferiority could not be demonstrated. The LNG‐IUS is reversible and less invasive and can be a cost‐effective treatment option, depending on the success rate women are willing to accept. Tweetable abstract Treatment of heavy menstrual bleeding starting with LNG‐IUS is cheaper but slightly less effective than endometrial ablation. Treatment of heavy menstrual bleeding starting with LNG‐IUS is cheaper but slightly less effective than endometrial ablation.
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Affiliation(s)
- M J van den Brink
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - P Beelen
- Department of General Practice, University of Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - M C Herman
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - P M Geomini
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - J H Dekker
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - K M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Obstetrics and Gynaecology, Grow Research School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - M Y Berger
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Panman C, Wiegersma M, Kollen BJ, Berger MY, Lisman-Van Leeuwen Y, Vermeulen KM, Dekker JH. Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: a randomised controlled trial in primary care. BJOG 2016; 124:511-520. [PMID: 26996291 DOI: 10.1111/1471-0528.13992] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare effects and cost-effectiveness of pelvic floor muscle training (PFMT) and watchful waiting in women with pelvic organ prolapse. DESIGN Randomised controlled trial. SETTING Dutch general practice. POPULATION Women (≥55 years) with symptomatic mild prolapse, identified by screening. METHODS Linear multilevel analysis. MAIN OUTCOME MEASURES Primary outcome was change of pelvic floor symptoms (Pelvic-Floor-Distress-Inventory-20 [PFDI-20]) during 24 months. Secondary outcomes were condition-specific and general quality of life, costs, sexual functioning, prolapse stage, pelvic floor muscle function and women's perceived improvement of symptoms. RESULTS PFMT (n = 145) resulted in a 12.2-point (95% CI 7.2-17.2, P < 0.001) greater improvement in PFDI-20 score during 24 months compared with watchful waiting (n = 142). Participants randomised to PFMT more often reported improved symptoms (43% versus 14% for watchful waiting). Direct medical costs per person were €330 for PFMT and €91 for watchful waiting but costs for absorbent pads were lower in the PFMT group (€40 versus €77). Other secondary outcomes did not differ between groups. Post-hoc subgroup analysis demonstrated that PFMT was more effective in women experiencing higher pelvic floor symptom distress at baseline. CONCLUSION PFMT resulted in greater pelvic floor symptom improvement compared with watchful waiting. The difference was statistically significant, but below the presumed level of clinical relevance (15 points). PFMT more often led to women's perceived improvement of symptoms, lower absorbent pads costs, and was more effective in women experiencing higher pelvic floor symptom distress. Therefore, PFMT could be advised in women with bothersome symptoms of mild prolapse. TWEETABLE ABSTRACT Pelvic floor muscle training can be effective in women with bothersome symptoms of mild prolapse.
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Affiliation(s)
- Cmcr Panman
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - M Wiegersma
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - B J Kollen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - M Y Berger
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Y Lisman-Van Leeuwen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - K M Vermeulen
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - J H Dekker
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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3
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Vermeulen KM, Visser E, Messelink EJ, Schram AJ, Berger MY, Bock GH, Dekker JH. Cost‐effectiveness of a pro‐active approach of urinary incontinence in women. BJOG 2016; 123:1213-20. [DOI: 10.1111/1471-0528.13856] [Citation(s) in RCA: 8] [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] [Accepted: 11/15/2015] [Indexed: 11/29/2022]
Affiliation(s)
- KM Vermeulen
- Department of Epidemiology University of Groningen University Medical Centre Groningen Groningen the Netherlands
| | - E Visser
- Department of General Practice University of Groningen University Medical Centre Groningen Groningen the Netherlands
| | - EJ Messelink
- Department of Urology University of Groningen University Medical Centre Groningen Groningen the Netherlands
| | - AJ Schram
- Department of Obstetrics and Gynaecology University of Groningen University Medical Centre Groningen Groningen the Netherlands
| | - MY Berger
- Department of General Practice University of Groningen University Medical Centre Groningen Groningen the Netherlands
| | - GH Bock
- Department of Epidemiology University of Groningen University Medical Centre Groningen Groningen the Netherlands
| | - JH Dekker
- Department of General Practice University of Groningen University Medical Centre Groningen Groningen the Netherlands
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Damen-van Beek Z, Teunissen D, Dekker JH, Lagro-Janssen ALM, Berghmans LCM, Uijen JHJM, Mientjes GHC, Wiersma T. [Practice guideline 'Urinary incontinence in women' from the Dutch College of General Practitioners]. Ned Tijdschr Geneeskd 2016; 160:D674. [PMID: 27484432] [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: 06/06/2023]
Abstract
- The Dutch College of General Practitioners' (NHG) practice guideline 'Urinary incontinence in women' provides guidelines for diagnosis and management of stress, urgency and mixed urinary incontinence in adult women.- General practitioners (GPs) should be alert to signals for urinary incontinence in women and offer active diagnosis and treatment if necessary.- Shared decision making is central in the guideline; the GP and the patient should discuss therapeutic options and decide on treatment policy in mutual consultation.- Women with stress urinary incontinence can choose between pelvic floor exercises or a pessary as initial treatment. Placing a midurethral sling (MUS) will be discussed if initial treatment is insufficiently effective or in the case of serious symptoms.- When bladder training is ineffective in urgency incontinence, the GP will discuss the pros and cons of adding an anticholinergic agent.- Exercise therapy can take place in the GPs practice or under supervision of a pelvic physical therapist.
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Affiliation(s)
- Z Damen-van Beek
- Nederlands Huisartsen Genootschap, afd. Richtlijnontwikkeling en Wetenschap, Utrecht, The Netherlands
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5
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De Bock GH, Van Kampen IM, Van der Goot JH, Hamstra M, Dekker JH, Schuit KW, Van der Meer K. Transfer of information on palliative home care during the out-of-hours period. Fam Pract 2011; 28:280-6. [PMID: 21156753 DOI: 10.1093/fampra/cmq104] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Continuity of end-of-life care for patients receiving palliative care is an important challenge for out-of-hours services in general practice. AIM To investigate how frequent information is transferred on patients receiving palliative care from GPs to the out-of-hours services, to explore the perceptions of GP's on this information transfer and to study the relation between information transfer and the used GP information systems. METHODS This is a mixed-method design study. The frequency of information transfer to the out-of-hours services was investigated by analyzing a regional out-of-hours database. Barriers and promoting factors for this transfer of information were investigated by using semi-structured interviews among a purposive sample of GPs from the same region. The relation between information transfer and the GP information system was investigated by a postal questionnaire in a national random selection of GPs. RESULTS When a palliative patient contacted the out-of-hours service, for 20% of these patients, a transfer of information was available and only half of these transfers included an anticipating end-of-life plan. All interviewed GPs considered continuity of care for these patients as important. However, some doubted whether a transfer of information is relevant for the quality of care. There was no relation between the information transfer and the used GP information systems. CONCLUSION For only a minority of patients receiving palliative care, a transfer of information including an anticipating management plan was present. There is a large variation in the opinions of GPs on how to organize continuity of end-of-life care.
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Affiliation(s)
- G H De Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Boukes FS, Boeke AJP, Dekker JH, Wiersma T, Goudswaard AN. [Summary of the practice guideline 'Vaginal discharge' (first revision) from the Dutch College of General Practitioners]. Ned Tijdschr Geneeskd 2007; 151:1339-43. [PMID: 17665625] [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: 05/16/2023]
Abstract
The 1996 practice guideline of the Dutch College of General Practitioners (NHG) on vaginal discharge has been updated. Most women who visit their doctor with complaints about vaginal discharge do not have an increased risk of a sexually-transmitted disease. Investigations into vaginal discharge comprise history taking, physical examination and microscopic analysis in the laboratory of the general practitioner. Additional investigation into Chlamydia, gonorrhoea and Trichomonas infection is only necessary if the patient history reveals an increased risk of a sexually-transmitted disease. A Candida infection or bacterial vaginosis should only be treated if the patient experiences bothersome complaints. Treatment of a Candida infection consists of a vaginally applied imidazole compound. Bacterial vaginosis can be treated with oral administration of metronidazole. Patients with vaginal fluor can be examined and, if necessary, treated by their general practitioner. Referral to a gynaecologist is rarely necessary.
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Affiliation(s)
- F S Boukes
- Nederlands Huisartsen Genootschap, afd. Richtlijnontwikkeling en Wetenschapsbeleid, Postbus 3231, 3502 GE Utrecht.
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7
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Boukes FS, Dekker JH, Wiersma T, Goudswaard AN. [The practice guideline 'Pelvic inflammatory disease' (first revision) from the Dutch College of General Practitioners; a response from the perspective of gynaecology]. Ned Tijdschr Geneeskd 2007; 151:837-8. [PMID: 17471616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Boukes FS, Dekker JH, Wiersma TJ, Goudswaard AN. [Summary of the practice guideline 'Pelvic inflammatory disease' (first revision) from the Dutch College of General Practitioners]. Ned Tijdschr Geneeskd 2007; 151:753-6. [PMID: 17471777] [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: 05/15/2023]
Abstract
The 1995 guideline on pelvic inflammatory disease (PID) has been updated. The general practitioner should consider PID whenever a woman of childbearing age complains of lower abdominal pain; the diagnosis should then be based on 5 criteria: (a) non-acute lower abdominal pain; (b) pain on upward movement or adnexal tenderness during vaginal touch; (c) painful or swollen adnexae; (d) ESR > or = 15 mm in the 1st hour or a temperature > 38 degree C, and (e) no indications for other diseases, such as appendicitis or an extra-uterine pregnancy. In case of diagnostic doubt, a gynaecologist must be consulted. Rapid treatment with antibiotics diminishes symptoms, shortens the course of disease, and may prevent complications such as infertility or extra-uterine pregnancy. Treatment should be started with ofloxacin and metronidazole. Due to the increasing antibiotic resistance of Neisseria gonorrhoeae, when there are indications for this pathogen the medicinal treatment should immediately be directed at it by means of cefotaxim, doxycycline and metronidazole. In his or her information to the patient, the general practitioner should devote attention to the major role of sexually transmissible micro-organisms and give advice, if necessary, regarding high-risk behaviour.
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Affiliation(s)
- F S Boukes
- Nederlands Huisartsen Genootschap, Postbus 3231, 3502 GE Utrecht.
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9
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Dekker JH. [The Dutch Health Council report on screening for Chlamydia: too reserved]. Ned Tijdschr Geneeskd 2005; 149:850-2. [PMID: 15868986] [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: 05/02/2023]
Abstract
The prevalence of sexually transmitted diseases (STDs) increased in the Netherlands in the years 2000-2003. A recent population-based study showed that Chlamydia infections were a problem in urbanised areas; prevalence in rural areas was low. In 2004, the Dutch Health Council advised against a national screening programme for Chlamydia. However, the newest figures on the distribution of Chlamydia infections suggest that screening in large cities might be cost-effective. Much can be learned from the screening programme in the United Kingdom.
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Affiliation(s)
- J H Dekker
- Universitair Medisch Centrum Groningen, afd. Huisartsgeneeskunde, Postbus 30.001, 9700 RB Groningen.
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10
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Snels IA, Beckerman H, Twisk JW, Dekker JH, Koppe PA, Lankhorst GJ, Bouter LM. Effect of triamcinolone acetonide injections on hemiplegic shoulder pain : A randomized clinical trial. Stroke 2000; 31:2396-401. [PMID: 11022070 DOI: 10.1161/01.str.31.10.2396] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [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: 11/16/2022]
Abstract
UNLABELLED Background and Purpose-Hemiplegic shoulder pain is not uncommon after stroke. Its origin is still unknown, and although many different methods of treatment are applied, none have yet been proved to be effective. We sought to study the efficacy of 3 injections of intra-articular triamcinolone acetonide on pain and arm function in stroke patients with hemiplegic shoulder pain. METHODS -In a multicenter, randomized, placebo-controlled clinical trial, patients with hemiplegic shoulder pain received either 3 intra-articular injections of 40 mg triamcinolone acetonide or 1 mL physiological saline solution (placebo). Primary outcomes were pain measured according to 3 visual analogue scales (score range, 0 to 10), and arm function was measured by means of the Action Research Arm test and the Fugl-Meyer assessment scale; secondary outcomes were passive external rotation of the shoulder and general functioning measured according to Barthel Index and the Rehabilitation Activities Profile. RESULTS -In the triamcinolone group (n=18), the median decrease in pain, 3 weeks after the last injection, was 2.3 (interquartile range, 0.3 to 4.3) versus 0.2 (interquartile range, -0.5 to 2.2) in the placebo group. This result was not statistically significant. The change in the other outcome measures did not differ significantly between the 2 treatment groups. Twenty-five patients reported side effects. CONCLUSIONS -In the 37 participants included in this study, triamcinolone injections seemed to decrease hemiplegic shoulder pain and to accelerate recovery, but this effect was not statistically significant. Therefore, on the basis of the results of this study, these injections cannot be recommended for the treatment of patients with hemiplegic shoulder pain.
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Affiliation(s)
- I A Snels
- Department of Rehabilitation Medicine, University Hospital, Vrije Universiteit, Amsterdam (I.A.K.S., H.B., G.J.L.)
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11
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Abstract
AIMS To identify neuropathic sensory symptoms associated with a clinical neurological examination (CNE) and to investigate whether these symptoms could be used as a diagnostic or screening tool for diabetic polyneuropathy in general practice. METHODS Five hundred and eighty-eight patients with Type 2 diabetes, recruited from 26 general practices in the Netherlands, underwent a CNE and completed a diabetes symptom checklist that included 10 items on neuropathic sensory symptoms. Linear regression analyses were performed to assess the association between neuropathic symptoms and CNE. Receiver operating characteristic (ROC) curves were created to assess the diagnostic properties of neuropathic symptoms. RESULTS In this population, with a mean age of 66.8 years, 32% were identified with diabetic polyneuropathy according to the CNE. Variables that showed the strongest association with CNE score were age (beta = 0.41), symptoms of sensory alteration (beta = 0.27), and the item 'numbness of the feet' (beta = 0.35) in particular. ROC curves showed that prediction of diabetic polyneuropathy from these symptoms was unsatisfying. The sensitivity and specificity of daily symptoms of 'numbness of the feet' were 28% and 93%, respectively, in patients <68 years, and 22% and 92%, respectively, in patients > or =68 years. CONCLUSIONS Identification of neuropathic sensory symptoms is not useful as a diagnostic or even a screening tool in the assessment of diabetic neuropathy in daily practice. Therefore, the results reported in this paper mandate an annual foot examination by the general practitioner.
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Affiliation(s)
- L V Franse
- Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
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Bouma M, Dekker JH, van Eijk JT, Schellevis FG, Kriegsman DM, Heine RJ. Metabolic control and morbidity of type 2 diabetic patients in a general practice network. Fam Pract 1999; 16:402-6. [PMID: 10493712 DOI: 10.1093/fampra/16.4.402] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
METHODS Glycaemic control and the prevalence of modifiable cardiovascular risk factors, and micro- and macrovascular morbidity was examined in 637 Type 2 diabetic patients in general practice, of whom 405 consented to undergo a more extensive examination. RESULTS In these 405 patients, HbA1c was > or = 7% in 56.6%, and hypertension and dyslipidaemia were found in 59.8% and 46.5% of the patients, respectively. The level of cardiovascular risk factors was acceptable, according to the European guidelines, in the following proportions of patients: BMI 45.0%; total cholesterol 69.1%; HDL-cholesterol 68.1%; triglycerides 67.8%; current blood pressure 89.8%; and smoking 21.0%. Retinopathy was present in 12.5% and microalbuminuria in 27.0% of the patients. In all 637 patients, the prevalence of angina pectoris was 17.7%, of myocardial infarction 11.4% and of congestive heart failure 10.7%. CONCLUSION The care for Type 2 diabetic patients needs improvement and should focus on cardiovascular risk factors as much as on glycaemic control.
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Affiliation(s)
- M Bouma
- Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands
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13
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Bouma M, Dekker JH, de Sonnaville JJ, van der Does FE, de Vries H, Kriegsman DM, Kostense PJ, Heine RJ, van Eijk JT. How valid is fasting plasma glucose as a parameter of glycemic control in non-insulin-using patients with type 2 diabetes? Diabetes Care 1999; 22:904-7. [PMID: 10372239 DOI: 10.2337/diacare.22.6.904] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the value of fasting blood glucose as a parameter for glycemic control in type 2 diabetic patients not using insulin. RESEARCH DESIGN AND METHODS In 1,020 type 2 diabetic patients treated with diet or oral hypoglycemic agents (OHAs), measurements of fasting plasma glucose (FPG) and HbA1c were taken. In 617 patients, the measurement could be repeated after 3 months. Cross-sectional correlation coefficients were calculated for the association between HbA1c and FPG. Receiver-operating characteristic (ROC)-curve analyses were applied to examine the performance of FPG as a diagnostic test for HbA1c. Longitudinally, the change in FPG was compared with the change in HbA1c, with both correlation measures and ROC curve analyses. RESULTS Correlation coefficients between HbA1c and FPG and between FPG change and HbA1c change were 0.77 and 0.65, respectively. ROC curve analysis showed that HbA1c is difficult to predict from FPG values: 66% of the patients with good HbA1c (< 7.0%) were identified as such by FPG values < 7.8 mmol/l. As a test for HbA1c change, FPG change performed moderately: the highest combined values of sensitivity and specificity (87.7 and 57%, respectively) were reached at a cutoff point of zero in the range of FPG change values. CONCLUSIONS FPG and HbA1c values that do not correspond are not rare in type 2 diabetic patients on diet or OHA treatment. HbA1c is difficult to predict from FPG values, and even more difficult is the prediction of HbA1c changes from FPG changes.
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Affiliation(s)
- M Bouma
- Institute for Research in Extramural Medicine, Amsterdam, The Netherlands
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14
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van Valkengoed IG, Boeke AJ, van den Brule AJ, Morré SA, Dekker JH, Meijer CJ, van Eijk JT. [Systematic home screening for Chlamydia trachomatis infections of asymptomatic men and women in family practice by means of mail-in urine samples]. Ned Tijdschr Geneeskd 1999; 143:672-6. [PMID: 10321300] [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: 02/12/2023]
Abstract
OBJECTIVE To determine the prevalence and determinants of Chlamydia trachomatis (CT) infections among asymptomatic men and women in general practice. To determine participation rates in a systematic screening programme in general practice, using home obtained mailed urine samples. DESIGN Cross-sectional study. METHODS In 15 general practices in Amsterdam, the Netherlands, a sample of 11,005 persons (5541 women and 5464 men), aged 15-40 were invited to send in a urine sample and a completed questionnaire by mail. The urine samples were tested using the ligase chain reaction for DNA amplification. Patients diagnosed with CT were treated and partner notification was performed. RESULTS 33% of invited males (1809/5464) and 50% of females (2751/5541) sent in the study material. Older patients participated more frequently than younger patients. Participation rates among persons with a Dutch background were higher than rates among persons from other ethnic groups. In 42 men and 79 women a CT infection was identified (2.3% and 2.9% respectively). Infections were more prevalent in patients from Surinam and the Dutch Antilles and in the age category 21-25 years. Type of health insurance as a proxy measure of socioeconomic status was not an indicator of infection. CONCLUSION The participation in this systematic screening using mail-sent urine samples was 33% in men and 50% in women. The CT prevalences among asymptomatic men and women were 2.3% and 2.9% respectively.
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Affiliation(s)
- I G van Valkengoed
- Vrije Universiteit, Instituut voor Extramuraal Geneeskundig Onderzoek, Amsterdam
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15
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Abstract
Effects of intra-articular triamcinolone acetonide on pain and passive range of motion (ROM) in the painful hemiplegic shoulder were studied. A Multiple baseline (or AB) design across seven subjects was used. The length of the baseline condition (or A phase) was either 2 or 3 wk, and randomized across subjects. Subsequently, a treatment condition (or B phase) of 4 wk was applied during which three intra-articular injections of triamcinolone acetonide were administered at day 1, 8, and 22. Pain and ROM were the primary outcome parameters and were measured three times each week by means of a visual analogue scale (VAS) and a fluid-filled goniometer, respectively. In addition, a number of secondary outcome parameters were assessed, i.e., spastic muscle activity (Ashworth scale), motor function (Fugl-Meyer index), upper limb function (action research arm test) and signs and symptoms of a shoulder hand syndrome (clinical scoring list). Statistical analysis of the combined time series showed significant effects on pain (P = 0.025). Analysis of the individual time series revealed that five out of seven patients had significant reduction of pain. ROM improved significantly in four out of seven patients. However, improvement of ROM did not reach significance at the group level (P = 0.13). None of the secondary parameters showed significant changes. The correlation coefficient between upper limb function (ARA) at intake and size of treatment effect approached a level of significance (P = 0.09). The results indicate that intra-articular triamcinolone may be of benefit in reducing hemiplegic shoulder pain.
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Affiliation(s)
- J H Dekker
- Jan van Breemen Instituut, Amsterdam, the Netherlands
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Boeke AJ, Dekker JH, van Eijk JT, Kostense PJ, Bezemer PD. Effect of lactic acid suppositories compared with oral metronidazole and placebo in bacterial vaginosis: a randomised clinical trial. Genitourin Med 1993; 69:388-92. [PMID: 8244360 PMCID: PMC1195125 DOI: 10.1136/sti.69.5.388] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [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: 01/29/2023]
Abstract
OBJECTIVE To compare the effect of lactic acid locally, metronidazole orally and placebo in women with bacterial vaginosis. DESIGN Randomised clinical trial. SETTING 30 general practices in the Netherlands. PATIENTS 125 women consulting the general practitioner for symptomatic bacterial vaginosis. MAIN OUTCOME MEASURES Duration of subjective symptoms, recurrence of symptoms, clinically diagnosed cure, adverse events. RESULTS Survival analysis showed a significantly faster disappearance of symptoms in the metronidazole category compared with both lactic acid and placebo (p = 0.0005 metronidazole v placebo, p = 0.0002 metronidazole v lactic acid p = 0.6521 lactic acid v placebo [The stratified Mantel Cox test]). The median duration until absence of symptoms was 21 days for metronidazole and 80 days for placebo. Disappearance of symptoms did not occur in 50% of the lactic acid group in 90 days. Recurrence rates of symptoms were similar over the treatment categories (p = 0.13 metronidazole v placebo and p = 0.12 lactic acid v placebo). After 2 weeks cure rates (cure defined as less than three of four clinical criteria present) were 83%, 49% and 47% for metronidazole, lactic acid and placebo category respectively. At that time cure rates (cure defined as none of three clinical criteria present) were 10%, 0% and 3%. After four weeks and three months these figures were: 55%, 20%, 20% and 64%, 28%, 28%. No differences in adverse events were found between the three interventions. CONCLUSIONS Lactic acid suppositories are ineffective, metronidazole capsules are effective on signs and symptoms in bacterial vaginosis. A considerable proportion of the patients recover without active medication.
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Affiliation(s)
- A J Boeke
- Department of General Practice, Faculty of Medicine, Vrije Universiteit, Amsterdam, Netherlands
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Dekker JH, Boeke AJ, Janssens J, Van Eijk JT. Vaginal symptoms of unknown aetiology: a study in Dutch general practice. Br J Gen Pract 1993; 43:239-44. [PMID: 8373647 PMCID: PMC1372421] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Vaginal symptoms are frequently presented by women to general practitioners. In many cases, the aetiology of these symptoms remains unknown. This study focused on the factors associated with microbiologically unexplained vaginal symptoms, the course of symptoms and signs in these cases, and factors modifying this course. In a group of 610 women presenting to their general practitioner with vaginal symptoms (itching, irritation, abnormal but non-bloody discharge) the distribution of diagnoses was studied and factors associated with symptoms of unknown aetiology were identified using logistic regression analysis. During a three month follow up, the course of symptoms and signs was studied in 139 women with unexplained vaginal symptoms, using survival analysis methods. It was found that 25% of all the women had symptoms of unknown aetiology. A larger number of these women, compared with women with other diagnoses, were Caucasian, married, more highly educated, used oral contraceptives and reported psychological distress. During the follow-up period, a specific infection was diagnosed in less than 20% of the women with unexplained vaginal symptoms. Over half of the women (54%) recovered within three months. Short duration of symptoms before presentation was associated with a higher probability of recovery. From the study, it was found that many women visiting the general practitioner for vaginal symptoms had no demonstrable microbial disorder. Often these symptoms were transient and disappeared without intervention. Persistent symptoms may call for further examination where somatic, as well as psychosocial, factors should be taken into account.
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Affiliation(s)
- J H Dekker
- Department of General Practice and Nursing Home Medicine, Vrije Universiteit, Amsterdam, The Netherlands
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Abstract
OBJECTIVE To determine the agreement of culture results of Candida albicans and Trichomonas vaginalis from the cervix versus posterior fornix in women with vaginal symptoms. DESIGN Same patient comparison of culture results from two sample sites. SETTING Twenty one general practices in Amsterdam and the east of the Netherlands. SUBJECTS Six hundred and eighty two women aged 15 to 55 years with vaginal symptoms, seen between 1 October 1987 and 31 May 1990. MAIN OUTCOME MEASURES For each site (cervix and posterior fornix) the proportion of detected C albicans and T vaginalis. The sensitivity of the cervical swab related to the vaginal one. The percentage of concordance for both microorganisms. RESULTS In 248 (34%) women C albicans was diagnosed and in 38 (6%) T vaginalis. In 99% of the proven C albicans cases, the yeast was found in the vagina. In 94% C albicans was isolated from the cervix. Sensitivity of the cervical swab was 94%. In 98% of the patients a concordant observation was made regarding detection of yeast. In 97% of the proven T vaginalis cases the protozoon was found in the vagina. In 91% T vaginalis was detected from the cervical swab. Sensitivity of the cervical swab was 92%. The culture results were concordant in 99%. CONCLUSION The yield from the vaginal source was slightly better than that from the cervix for culture of both microorganisms. For screening purposes, specimen-collection for culture of N gonorrhoeae, C albicans and T vaginalis can be combined in one swab taken from the cervix.
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Affiliation(s)
- A J Boeke
- Department of General Practice, Faculty of Medicine, Vrije Universiteit, The Netherlands
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Dekker JH, Burmester RG. Pleiotropy in Triazine-Resistant Brassica napus: Ontogenetic and Diurnal Influences on Photosynthesis. Plant Physiol 1992; 100:2052-8. [PMID: 16653239 PMCID: PMC1075906 DOI: 10.1104/pp.100.4.2052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Studies were conducted that supported the hypothesis that the mutation to the psbA plastid gene that confers S-triazine resistance (R) in Brassica napus also results in an altered diurnal pattern of photosynthetic carbon assimilation (A) relative to that of the susceptible (S) wild type, and that these patterns change over the ontogeny of a plant. Photosynthetic photon flux density, under closely controlled environmental conditions, was incrementally increased and decreased on either side of the midday maxima of 1150 to 1300 mumol quanta m(-2) s(-1). In all experiments, A approximately tracked the increasing and decreasing diurnal light levels. Younger (3- to 4-leaf) R plants had greater photosynthetic rates early and late in the diurnal light period, whereas those of S plants were greater during midday as well as during the photoperiod as a whole. These relative photosynthetic characteristics of R and S plants changed in several ways with ontogeny. As the plants aged during the vegetative phase of development, S plants gradually assimilated more carbon in the early, and then in the late, part of the day. At the end of the vegetative phase of development, R plant carbon assimilation was less relative to S plants at most times of the day, and was never greater. This relationship between the two biotypes dramatically changed with the onset of the reproductive phase (8(1/2) to 9(1/2) leaf) of plant development: R plants assimilated more carbon than S plants during all periods of the diurnal light period with the exception of the late part of the day. In addition to these differences in A, R plant stomatal function differed from that in S plants. R plant leaves were always cooler than S plant leaves under the same environmental and diurnal conditions. Correlated with this difference in leaf temperature were equal or greater total conductances to water vapor and intercellular CO(2) partial pressures in R compared to S leaves in most instances. These studies indicate a more complex pattern of photosynthetic carbon assimilation than previously observed. The photosynthetic superiority of one biotype relative to the other was a function of the time of day and the age of the plant. These studies also suggest that R plants may have an adaptive advantage over S plants in certain unfavorable ecological niches independent of the presence of S-triazine herbicides, such as cool, low-light environments early and late in the day, as well as late in the plants' development. This advantage could result in R biotypes appearing in populations of a species in greater numbers than plastidic mutation alone could cause.
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Affiliation(s)
- J H Dekker
- Department of Agronomy, Iowa State University, Ames, Iowa, 50011
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Abstract
The response of photosynthetic carbon assimilation and chlorophyll fluorescence quenching to changes in intercellular CO(2) partial pressure (C(i)), O(2) partial pressure, and leaf temperature (15-35 degrees C) in triazine-resistant and -susceptible biotypes of Brassica napus were examined to determine the effects of the changes in the resistant biotype on the overall process of photosynthesis in intact leaves. Three categories of photosynthetic regulation were observed. The first category of photosynthetic response, ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco)-limited photosynthesis, was observed at 15, 25, and 35 degrees C leaf temperatures with low C(i). When the carbon assimilation rate was Rubisco-limited, there was little difference between the resistant and susceptible biotypes, and Rubisco activity parameters were similar between the two biotypes. A second category, called feedback-limited photosynthesis, was evident at 15 and 25 degrees C above 300 microbars C(i). The third category, photosynthetic electron transport-limited photosynthesis, was evident at 25 and 35 degrees C at moderate to high CO(2). At low temperature, when the response curves of carbon assimilation to C(i) indicated little or no electron transport limitation, the carbon assimilation rate was similar in the resistant and susceptible biotypes. With increasing temperature, more electron transport-limited carbon assimilation was observed, and a greater difference between resistant and susceptible biotypes was observed. These observations reveal the increasing importance of photosynthetic electron transport in controlling the overall rate of photosynthesis in the resistant biotype as temperature increases. Photochemical quenching of chlorophyll fluorescence (q(P)) in the resistant biotype never exceeded 60%, and triazine resistance effects were more evident when the susceptible biotype had greater than 60% q(P), but not when it had less than 60% q(P).
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Affiliation(s)
- J H Dekker
- Department of Agronomy, Iowa State University, Ames, Iowa 50011
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