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1.
Osteoarthritis Cartilage ; 31(4): 519-528, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36528309

RESUMO

OBJECTIVE: To determine the risk of comorbidity following diagnosis of knee or hip osteoarthritis (OA). DESIGN: A cohort study was conducted using the Integrated Primary Care Information database, containing electronic health records of 2.5 million patients from the Netherlands. Adults at risk for OA were included. Diagnosis of knee or hip OA (=exposure) and 58 long-term comorbidities (=outcome) were defined by diagnostic codes following the International Classification of Primary Care coding system. Time between the start of follow-up and incident diagnosis of OA was defined as unexposed, and between diagnosis of OA and the end of follow-up as exposed. Age and sex adjusted hazard ratios (HRs) comparing comorbidity rates in exposed and unexposed patient time were estimated with 99.9% confidence intervals (CI). RESULTS: The study population consisted of 1,890,712 patients. For 30 of the 58 studied comorbidities, exposure to knee OA showed a HR larger than 1. Largest positive associations (HR with (99.9% CIs)) were found for obesity 2.55 (2.29-2.84) and fibromyalgia 2.06 (1.53-2.77). For two conditions a HR < 1 was found, other comorbidities showed no association with exposure to knee OA. For 26 comorbidities, exposure to hip OA showed a HR larger than 1. The largest were found for polymyalgia rheumatica 1.81 (1.41-2.32) and fibromyalgia 1.70 (1.10-2.63). All other comorbidities showed no associations with hip OA. CONCLUSION: This study showed that many comorbidities were diagnosed more often in patients with knee or hip OA. This suggests that the management of OA should consider the risk of other long-term-conditions.


Assuntos
Fibromialgia , Osteoartrite do Quadril , Osteoartrite do Joelho , Adulto , Humanos , Estudos de Coortes , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/epidemiologia , Fibromialgia/diagnóstico , Fibromialgia/epidemiologia , Países Baixos/epidemiologia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/epidemiologia , Comorbidade
2.
Osteoarthritis Cartilage ; 30(6): 843-851, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35307534

RESUMO

OBJECTIVE: To determine the incidence and prevalence of hip osteoarthritis (OA) in electronic health records (EHRs) of Dutch general practices by using narrative and codified data. METHOD: A retrospective cohort study was conducted using the Integrated Primary Care Information database. An algorithm was developed to identify patients with narratively diagnosed hip OA in addition to patients with codified hip OA. Incidence and prevalence estimates among people aged ≥30 were assessed from 2008 to 2019. The association of comorbidities with codified hip OA diagnosis was analysed using multivariable logistic regression. RESULTS: Using the hip OA narrative data algorithm (positive predicted value = 72%) in addition to codified hip OA showed a prevalence of 1.76-1.95 times higher and increased from 4.03% in 2008 to 7.34% in 2019. The incidence was 1.83-2.41 times higher and increased from 6.83 to 7.78 per 1000 person-years from 2008 to 2019. Among codified hip OA patients, 39.4% had a previous record of narratively diagnosed hip OA, on average approximately 1.93 years earlier. Hip OA patients with a previous record of spinal OA, knee OA, hypertension, and hyperlipidaemia were more likely to be recorded with a hip OA code. CONCLUSION: This study using Dutch EHRs showed that epidemiological estimates of hip OA are likely to be an underestimation. Using our algorithm, narrative data can be added to codified data for more realistic epidemiological estimates based on routine healthcare data. However, developing a valid algorithm remains a challenge, possibly due to the diagnostic complexity of hip pain in general practice.


Assuntos
Osteoartrite do Quadril , Osteoartrite do Joelho , Estudos de Coortes , Registros Eletrônicos de Saúde , Humanos , Incidência , Prevalência , Estudos Retrospectivos
3.
Osteoporos Int ; 31(12): 2425-2438, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32757044

RESUMO

Strontium ranelate use, compared with oral bisphosphonates, is not associated with increased risk of AMI in patients with no contraindications for SR use. However, current strontium ranelate (compared with current bisphosphonate) appears associated with 25-30% excess risk of VTE and 35% excess risk of CVDeath. INTRODUCTION: Evaluate the risk of cardiac and thromboembolic events among new users of SR and oral BPs without contraindications for SR. METHODS: We conducted three multi-national, multi-database (Aarhus-Denmark, HSD-Italy, IPCI-Netherlands, SIDIAP-Spain, THIN-UK) case-control studies nested within a cohort of new users of SR/BP. We matched cases of acute myocardial infarction (AMI), venous thromboembolism (VTE), and cardiovascular death (CVDeath), up to 10 controls on gender, year of birth, index date, and country. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs) according to current SR vs current BP use and current vs past SR use, adjusting for potential confounders. Data were pooled using random effects meta-analysis. RESULTS: No excess risk of AMI (5477 cases/54,674 controls) was found with current SR vs current BP (OR 0.89 (95%CI 0.70, 1.12)) nor with current vs past SR use (0.71(0.56, 0.91)). For VTE (5614 cases/6036 controls), an excess risk was found with current SR compared with current BP use, 1.24 (0.96, 1.61), and current vs past SR use, 1.30 (1.04, 1.62). For CVDeath (3019 cases/29,871 controls), an increased risk was seen with current SR vs current BP use, 1.35 (1.02, 1.80), but not with current vs past SR use (0.68 (0.48, 0.96)). CONCLUSION: In patients without contraindications for SR, we found no evidence of an increased risk of AMI but a 25-30% excess risk of VTE and a 35% excess risk of CVDeath with current SR vs current BP users. This is despite a reduction in risk in CVDeath with current vs past SR users. The latter disparity could still be partially explained by cessation of preventative therapies in end-of-life or residual confounding by indication.


Assuntos
Conservadores da Densidade Óssea , Difosfonatos , Conservadores da Densidade Óssea/efeitos adversos , Estudos de Casos e Controles , Difosfonatos/efeitos adversos , Humanos , Itália , Países Baixos , Espanha , Tiofenos
5.
Osteoporos Int ; 31(4): 721-755, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31696274

RESUMO

INTRODUCTION: In May 2013 and March 2014, the European Medicines Agency (EMA) issued two decisions restricting the use of strontium ranelate (SR). These risk minimisation measures (RMM) introduced new contraindications and limited the indications of SR therapy. The EMA required an assessment of the impact of RMMs on the use of SR in Europe. Methods design: multi-national, multi-database cohort Setting: electronic medical record databases based on hospital (Denmark) and primary care provenance (Italy, Spain, the Netherlands, UK). PARTICIPANTS: the database source populations were included for population-based analyses, and SR users for patient-level analyses. INTERVENTION: New RMMs included contraindications (ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, uncontrolled hypertension) and restricted SR indication to severe osteoporosis with initiation by experienced physician and not as first line anti-osteoporosis therapy. METHODS: Prevalence and incidence rates of SR use in the population; prevalence of contraindications and restricted indications in SR users, plus 1-year therapy persistence. Drug use measures were calculated in three periods for comparison: reference (2004 to May 2013), transition (June 2013 to March 2014) and assessment (from April 2014 to end 2016). RESULTS: The study population included 143 million person-years(PY) of follow-up and 76,141 incident episodes of SR treatment. Average monthly prevalence rates of SR use dropped by 86.4% from 62.6/10,000 PY (95 CI 62.4-62.9) in the reference to 8.5 (8.5-8.6) in the assessment period. Similarly, the incidence rate of SR use fell by 97.3% from 7.4/10,000 PY (7.4-7.4) to 0.2 (0.2-0.2) between the reference and assessment period. The prevalence of any contraindication decreased, whilst the prevalence of restricted indications increased in these periods. One-year persistence decreased in the assessment compared with reference period. CONCLUSIONS: Our study demonstrates a substantial impact of the regulatory action to restrict use of SR in Europe: SR utilisation overall decreased strongly. The proportion of patients fulfilling the restricted indications, without contraindications, increased after the proposed RMMs.


Assuntos
Conservadores da Densidade Óssea , Compostos Organometálicos , Tiofenos/uso terapêutico , Conservadores da Densidade Óssea/uso terapêutico , Estudos de Coortes , Europa (Continente)/epidemiologia , Política de Saúde , Humanos , Itália , Países Baixos , Espanha
6.
Br J Dermatol ; 181(3): 544-553, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30636037

RESUMO

BACKGROUND: The high prevalence of actinic keratosis (AK) requires the optimal use of healthcare resources. OBJECTIVES: To gain insight in to the healthcare utilization of people with AK in a population-based cohort, and the management of AK in a primary and secondary care setting. METHODS: A retrospective cohort study using three complementary data sources was conducted to describe the use of care, diagnosis, treatment and follow-up of patients with AK in the Netherlands. Data sources consisted of a population-based cohort study (Rotterdam Study), routine general practitioner (GP) records (Integrated Primary Care Information) and nationwide claims data (DRG Information System). RESULTS: In the population-based cohort (Rotterdam Study), 69% (918 of 1322) of participants diagnosed with AK during a skin-screening visit had no previous AK-related visit in their GP record. This proportion was 50% for participants with extensive AK (i.e. ≥ 10 AKs; n = 270). Cryotherapy was the most used AK treatment by both GPs (78%) and dermatologists (41-56%). Topical agents were the second most used treatment by dermatologists (13-21%) but were rarely applied in primary care (2%). During the first AK-related GP visit, 31% (171 of 554) were referred to a dermatologist, and the likelihood of being referred was comparable between low- and high-risk patients, which is inconsistent with the Dutch general practitioner guidelines for 'suspicious skin lesions' from 2017. Annually, 40 000 new claims representing 13% of all dermatology claims were labelled as cutaneous premalignancy. Extensive follow-up rates (56%) in secondary care were registered, while only 18% received a claim for a subsequent cutaneous malignancy in 5 years. CONCLUSIONS: AK management seems to diverge from guidelines in both primary and secondary care. Underutilization of field treatments, inappropriate treatments and high referral rates without proper risk stratification in primary care, combined with extensive follow-up in secondary care result in the inefficient use of healthcare resources and overburdening in secondary care. Efforts directed to better risk differentiation and guideline adherence may prove useful in increasing the efficiency in AK management. What's already known about this topic? The prevalence of actinic keratosis (AK) is high and, in particular, multiple AKs are a strong skin cancer predictor. The high prevalence of AK requires optimal use of healthcare resources. Nevertheless, (population based) AK healthcare utilization and management data are very rare. What does this study add? Although AK-related care already consumes substantial resources, about 70% of the AK population has never received care. Primary care AK management demonstrated underutilization of topical therapies and high referral rates without proper risk stratification, while in secondary care the extensive follow-up schedules were applied. This inefficient use of healthcare resources highlights the need for better harmonization and risk stratification to increase the efficiency of AK care.


Assuntos
Ceratose Actínica/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Secundária à Saúde/estatística & dados numéricos , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Assistência ao Convalescente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Crioterapia/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Fármacos Dermatológicos/uso terapêutico , Dermatologistas/normas , Dermatologistas/estatística & dados numéricos , Feminino , Clínicos Gerais/normas , Clínicos Gerais/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Ceratose Actínica/diagnóstico , Masculino , Pessoa de Meia-Idade , Países Baixos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Atenção Primária à Saúde/normas , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco/normas , Medição de Risco/estatística & dados numéricos , Atenção Secundária à Saúde/normas
7.
J Biomed Inform ; 66: 72-81, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27993747

RESUMO

INTRODUCTION: Drug safety researchers seek to know the degree of certainty with which a particular drug is associated with an adverse drug reaction. There are different sources of information used in pharmacovigilance to identify, evaluate, and disseminate medical product safety evidence including spontaneous reports, published peer-reviewed literature, and product labels. Automated data processing and classification using these evidence sources can greatly reduce the manual curation currently required to develop reference sets of positive and negative controls (i.e. drugs that cause adverse drug events and those that do not) to be used in drug safety research. METHODS: In this paper we explore a method for automatically aggregating disparate sources of information together into a single repository, developing a predictive model to classify drug-adverse event relationships, and applying those predictions to a real world problem of identifying negative controls for statistical method calibration. RESULTS: Our results showed high predictive accuracy for the models combining all available evidence, with an area under the receiver-operator curve of ⩾0.92 when tested on three manually generated lists of drugs and conditions that are known to either have or not have an association with an adverse drug event. CONCLUSIONS: Results from a pilot implementation of the method suggests that it is feasible to develop a scalable alternative to the time-and-resource-intensive, manual curation exercise previously applied to develop reference sets of positive and negative controls to be used in drug safety research.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Processamento Eletrônico de Dados , Bases de Conhecimento , Farmacovigilância , Sistemas de Notificação de Reações Adversas a Medicamentos , Humanos
8.
Osteoporos Int ; 27(5): 1857-67, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26694594

RESUMO

UNLABELLED: Analyses of healthcare data from 30 million individuals in three countries showed that current use of bisphosphonates may be associated with a small increased risk of cardiac valvulopathy (vs. those not exposed within the previous year), although confounding cannot be entirely ruled out. The observed tendency for decreased valvulopathy risk with cumulative duration of bisphosphonate use >6 months may even indicate a protective effect with prolonged use. Further studies are still needed to evaluate whether bisphosphonates increase or decrease the risk of valvulopathy. INTRODUCTION: A signal of cardiac valve disorders with use of bisphosphonates was identified in the literature and EudraVigilance database, which contains reports of suspected adverse drug reactions from worldwide sources. The aim of this study was to evaluate the association using population-based healthcare data. METHODS: This was a case-control study among users of bisphosphonates and other drugs for osteoporosis in six healthcare databases covering over 30 million individuals in Italy, Netherlands and the UK from 1996 to 2012. Prescriptions/dispensations were used to assess drug exposure. Newly diagnosed cases of cardiac valvulopathy were identified via disease codes/free-text search. Controls were matched to each case by age, sex, database and index date. Adjusted odds ratios (ORs) were estimated using conditional logistic regression for the pooled data and meta-analysis of individual database risk estimates. RESULTS: A small but statistically significant association was found between exposure to bisphosphonates as a class and risk of valvulopathy. Overall risk was 18 % higher (95 % CI 12-23 %) in those currently exposed to any bisphosphonate (mainly alendronate and risedronate) vs. those not exposed within the previous year. Risk of valve regurgitation was 14 % higher (95 % CI 7-22 %). Decreased valvulopathy risk was observed with longer cumulative duration of bisphosphonate use, compared to use of less than 6 months. Meta-analyses of database-specific estimates confirmed results from pooled analyses. CONCLUSIONS: The observed increased risks of cardiac valvulopathy with bisphosphonate use, although statistically significant, were quite small and unlikely to be clinically significant. Further studies are still needed to evaluate whether bisphosphonates increase or decrease the risk of valvulopathy and to investigate possible mechanisms for the association.


Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Doenças das Valvas Cardíacas/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/administração & dosagem , Estudos de Casos e Controles , Bases de Dados Factuais , Difosfonatos/administração & dosagem , Esquema de Medicação , Substituição de Medicamentos , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia , Medição de Risco/métodos , Sensibilidade e Especificidade , Reino Unido/epidemiologia
9.
Eur J Pediatr ; 174(5): 641-9, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25367054

RESUMO

UNLABELLED: Since the introduction of the bivalent human papilloma virus (HPV) vaccine in the Netherlands, migraine has been reported as a notable event in the passive safety surveillance system. Research on the association between HPV vaccination and migraine is needed. Therefore, potential migraine cases in 2008-2010 were selected from a group of general practitioners and linked to the vaccination registry. Data were analysed in three ways: (i) incidences of migraine postvaccination (2009/2010) were compared to pre-vaccination incidences (2008); (ii) in a cohort, incidence rates of migraine in vaccinated and unvaccinated girls were compared and (iii) in a self-controlled case series analysis, the relative incidence of migraine in potentially high-risk periods was compared to non-high-risk periods. Incidence rates of migraine for 12- to 16-year-old girls and boys postvaccination were slightly higher than pre-vaccination incidence rates. Incidence rate ratios (IRRs) for vaccinated compared to unvaccinated girls were not statistically significantly higher. Furthermore, the RR for migraine in the high-risk period of 6 weeks following each dose versus non-high-risk period was 4.3 (95% confidence interval (CI) 0.69-26.6) for certain migraine. CONCLUSION: Using different methods, no statistically significant association between HPV vaccination and incident migraine was found. However, the number of cases was low; to definitively exclude the risk, an increased sample size is needed.


Assuntos
Transtornos de Enxaqueca/etiologia , Vacinas contra Papillomavirus/efeitos adversos , Vacinação/efeitos adversos , Adolescente , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Países Baixos , Infecções por Papillomavirus/prevenção & controle
10.
J Intern Med ; 275(6): 551-61, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24635221

RESUMO

A growing number of international initiatives (e.g. EU-ADR, Sentinel, OMOP, PROTECT and VAESCO) are based on the combined use of multiple healthcare databases for the conduct of active surveillance studies in the area of drug and vaccine safety. The motivation behind combining multiple healthcare databases is the earlier detection and validation, and hence earlier management, of potential safety issues. Overall, the combination of multiple healthcare databases increases statistical sample size and heterogeneity of exposure for postmarketing drug and vaccine safety surveillance, despite posing several technical challenges. Healthcare databases generally differ by underlying healthcare systems, type of information collected, drug/vaccine and medical event coding systems and language. Therefore, harmonization of medical data extraction through homogeneous coding algorithms across highly different databases is necessary. Although no standard procedure is currently available to achieve this, several approaches have been developed in recent projects. Another main challenge involves choosing the work models for data management and analyses whilst respecting country-specific regulations in terms of data privacy and anonymization. Dedicated software (e.g. Jerboa) has been produced to deal with privacy issues by sharing only anonymized and aggregated data using a common data model. Finally, storage and safe access to the data from different databases requires the development of a proper remote research environment. The aim of this review is to provide a summary of the potential, disadvantages, methodological issues and possible solutions concerning the conduct of postmarketing multidatabase drug and vaccine safety studies, as demonstrated by several international initiatives.


Assuntos
Bases de Dados Factuais , Monitoramento de Medicamentos/métodos , Registros Eletrônicos de Saúde/organização & administração , Vigilância de Produtos Comercializados/métodos , Sistemas de Notificação de Reações Adversas a Medicamentos/organização & administração , Humanos , Avaliação das Necessidades , Preparações Farmacêuticas/normas , Vigilância da População/métodos , Vacinas/normas
11.
Emerg Med J ; 27(7): 512-6, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20515904

RESUMO

OBJECTIVE: The authors aimed to assess the repeatability of the Manchester Triage System (MTS) in children. METHODS: All emergency department nurses (n=43) from a general teaching hospital and a university children's hospital in The Netherlands triaged 20 written case scenarios using the Manchester Triage system. Second, at two emergency departments (EDs), real-life simultaneous triage of patients (<16 years) was performed by ED nurses and two research nurses. The written case scenarios and the patients included in the real-life simultaneous triage study were representative of children attending the ED, in age, problem and urgency level. The authors assessed inter-rater agreement using quadratic weighted kappa values. RESULTS: The weighted kappa between the nurses, triaging the case scenarios, was 0.83 (95% CI 0.74 to 0.91). In total, 88% (N=198) of the eligible ED patients were triaged simultaneously, with a weighted kappa of 0.65 (95% CI 0.56 to 0.72). CONCLUSIONS: The MTS showed good to very good repeatability in paediatric emergency care.


Assuntos
Serviço Hospitalar de Emergência/normas , Triagem/métodos , Criança , Hospitais Pediátricos/normas , Hospitais de Ensino/normas , Hospitais Universitários/normas , Humanos , Países Baixos , Recursos Humanos de Enfermagem Hospitalar , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Triagem/normas
12.
Stud Health Technol Inform ; 160(Pt 1): 462-5, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20841729

RESUMO

BACKGROUND: Introducing a clinical decision support system (CDSS) in general practice that provides broad support based on all available guidelines for preventive care might dramatically increase the workload of a general practitioner. AIM: We evaluated the potential effect on workload of a CDSS that aims to support the whole breadth of preventive guidelines currently used in The Netherlands. METHODS: We analysed the guidelines of the Dutch college of General Practitioners (DCGP) for preventive activities, developed a CDSS based on the guidelines and studied the behaviour of the system on real patient data. RESULTS: 20 of the 87 DCGP guidelines contained data on preventive activities which was incorporated in the system. Out of 485,793 patients, the system indicated that for 138,885 (28.6%) a preventive action was needed. CONCLUSION: A CDSS that aims to support the whole breadth of preventive activities in general practice will have a substantial effect on workload. Further tailoring of the support will be needed.


Assuntos
Bases de Dados Factuais , Sistemas de Apoio a Decisões Clínicas/normas , Registros Eletrônicos de Saúde/normas , Medicina Geral/normas , Guias de Prática Clínica como Assunto , Medicina Preventiva/normas , Estudos de Viabilidade , Países Baixos
13.
Eur J Cancer ; 117: 32-40, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31229947

RESUMO

BACKGROUND: High incidence rates of keratinocyte carcinoma (KC) in Western countries put pressure on healthcare systems. The aim of this study was to describe clinical practice in order to identify areas for improvement. METHODS: A random selection of patients from the Integrated Primary Care Information database who consulted their general practitioner (GP) for suspicious or confirmed KC (n = 1597) was made in the analysis. For secondary care, 1569 patients with histologically confirmed KC were randomly selected from the Netherlands Cancer Registry. All patients were diagnosed between 2009 and 2013 and followed up until 2016. Details on diagnosis, treatment and care during follow-up were described. RESULTS: Among 942 patients who consulted their GP, KC was included in the working or differential diagnosis, but two-thirds (629) were not KC. If the GP suspected KC, the GP directly referred to a medical specialist in most cases (548 of 942). In half (470 of 967) of all confirmed KCs, a skin malignancy was not described in the initial working or differential diagnosis of the GP. The medical specialist treated the first primary KC in 86% (1369 of 1596) by excision, 4% (69 of 1596) by Mohs surgery and 10% (158 of 1596) by another treatment. Although follow-up is not recommended for low-risk basal cell carcinoma, 83% (29 of 35) received follow-up care. In contrast, 82% (60 of 73) patients with squamous cell carcinoma received less follow-up than recommended. CONCLUSIONS: Strengthening the diagnostic pathway for KC in primary care and reduction of low-value follow-up visits in secondary care seem potential areas for improving the efficiency of KC care.


Assuntos
Atenção à Saúde/normas , Clínicos Gerais/normas , Queratinócitos/patologia , Padrões de Prática Médica/normas , Melhoria de Qualidade , Neoplasias Cutâneas/terapia , Especialização/normas , Idoso , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/terapia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Países Baixos/epidemiologia , Prognóstico , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia
15.
J Hum Hypertens ; 22(10): 704-13, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18668128

RESUMO

The Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA) trial demonstrated the benefits of combined antihypertensive/lipid-lowering treatment over antihypertensive treatment alone in hypertensive patients with > or =3 additional cardiovascular (CV) risk factors. We assessed the prevalence and treatment of patients with hypertension and > or =3 additional CV risk factors in The Netherlands and Italy in a retrospective cohort study using the Integrated Primary Care Information (IPCI) database in The Netherlands and the Health Search/Thales Database (HSD) in Italy. Patients aged > or =16 years, with 1 year of valid database history, diagnosed and/or treated for hypertension (>140/90 mmHg) during 2000-2002 were included in the study. The IPCI and HSD populations consisted of approximately 175000 and approximately 325000 patients, respectively. The prevalence of hypertension increased from 20.3 to 22.3% in the IPCI, and from 19.0 to 21.8% in the HSD during 2000-2002. The prevalence of > or =3 concomitant risk factors among hypertensive patients increased from 31.2 and 31.1% in 2000 to 34.2 and 39.3% in 2002 in the IPCI and HSD, respectively. From 2000 to 2002, among hypertensive patients with > or =3 CV risk factors and no prior symptomatic CV disease (CVD) approximately 54-57% in the IPCI and 80-83% in the HSD received antihypertensive treatment. In these patients, the use of combined antihypertensive and lipid-lowering treatment increased from 14.2 to 17.6% in the IPCI and from 15.5 to 17.4% in the HSD from 2000 to 2002. This study shows that primary prevention of CVD in hypertensive patients in The Netherlands and Italy could be improved.


Assuntos
Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Adolescente , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Hipertensão/complicações , Hipolipemiantes/uso terapêutico , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
16.
Pediatr Pulmonol ; 42(4): 357-61, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17335011

RESUMO

This study compared results from Internet and written questionnaires about respiratory symptoms in order to find out if both forms of the survey yielded the same answers. One thousand seventy-one students, ages 13 to 17, were asked to complete either an Internet or a written questionnaire. The demographic characteristics of the participants equalled those of the general Dutch adolescent population. Participants were randomly assigned to fill out an electronic or written questionnaire. In addition to eight items from the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, two items on doctor visits (medical attention) regarding asthma or allergic disease during the past 12 months were included. The participation rate was 87%. The Internet version of the questionnaire showed fewer missing answers than the written version, but this was not statistically significant. The respiratory items did not show statistically significant score differences between the Internet and written modes of administration, and there was no visible trend for higher respectively lower scores by either mode of questionnaire administration. From these results, we conclude that respiratory questionnaires may be provided to adolescents electronically rather than on paper, since both approaches yielded equal results. To generalize these findings, we recommend repeated studies in other settings.


Assuntos
Asma/epidemiologia , Indicadores Básicos de Saúde , Internet , Sons Respiratórios , Inquéritos e Questionários , Adolescente , Feminino , Humanos , Masculino , Países Baixos/epidemiologia , Visita a Consultório Médico/estatística & dados numéricos
17.
IEEE Trans Inf Technol Biomed ; 11(3): 237-43, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17521073

RESUMO

This paper reports on an analysis of the bioinformatics and medical informatics literature with the objective to identify upcoming trends that are shared among both research fields to derive benefits from potential collaborative initiatives for their future. Our results present the main characteristics of the two fields and show that these domains are still relatively separated.


Assuntos
Biologia Computacional/tendências , Bases de Dados Bibliográficas/tendências , MEDLINE , Informática Médica/tendências , Processamento de Linguagem Natural , Publicações Periódicas como Assunto/tendências , Biologia Computacional/classificação , Biologia Computacional/estatística & dados numéricos , Internacionalidade , Informática Médica/classificação , Informática Médica/estatística & dados numéricos , Publicações Periódicas como Assunto/estatística & dados numéricos , Vocabulário Controlado
18.
Methods Inf Med ; 45(4): 447-54, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16964364

RESUMO

OBJECTIVE: We developed AsthmaCritic, a non-inquisitive critiquing system integrated with the general practitioners' electronic medical records. The system is based on the guidelines for asthma and chronic obstructive pulmonary disease (COPD) as issued by the Dutch College of General Practitioners. This paper assesses the effect of AsthmaCritic on monitoring and treatment of asthma and COPD by Dutch general practitioners in daily practice. METHODS: A randomized clinical trial in 32 practices (40 Dutch general practitioners) using electronic patient records. An intervention group was given the use of AsthmaCritic, a control group continued working in the usual manner. Both groups had the disposal of the asthma and COPD guidelines routinely distributed by the Dutch College of General Practitioners. We measured the average number of contacts, FEV 1 (forced expiratory volume), and peak-flow measurements per asthma/COPD patient per practice; and, the average number of antihistamine, cromoglycate, deptropine, and oral bronchodilator prescriptions per asthma/COPD patient per practice. RESULTS: The number of contacts increased in the age group of 12-39 years. The number of FEV1 , peak-flow measurements, and the ratio of coded measurements increased, whereas the number of cromoglycate prescriptions decreased in the age group of 12-39 years. CONCLUSIONS: Our study shows that the guideline-based critiquing system AsthmaCritic changed the manner in which the physicians monitored their patients and, to a lesser extent, their treatment behavior. In addition, the physicians changed their data-recording habits.


Assuntos
Sistemas de Informação em Atendimento Ambulatorial , Asma/tratamento farmacológico , Sistemas de Apoio a Decisões Clínicas , Uso de Medicamentos , Medicina de Família e Comunidade/normas , Fidelidade a Diretrizes , Padrões de Prática Médica , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Adolescente , Adulto , Criança , Tomada de Decisões , Monitoramento de Medicamentos , Medicina de Família e Comunidade/métodos , Retroalimentação , Feminino , Humanos , Masculino , Sistemas Computadorizados de Registros Médicos , Países Baixos
19.
Methods Inf Med ; 45(3): 305-9, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16685341

RESUMO

OBJECTIVE: To determine whether educators consider electronic patient record (EPR)-related education necessary and if so, what subjects have to be taught more extensively in the future. METHODS: A list of possibly relevant subjects was determined from the literature. A questionnaire was designed which contained those subjects and the respondents were asked to indicate, for each subject, its competency level and required competency level in current teaching. Since the response rate was low a second questionnaire was developed to have the results of the analysis of the first questionnaire validated by a larger group of educators. RESULTS: In total 45 learning goals were identified from the literature. The questionnaire was sent to representatives of several disciplines: basic medical education, medical specializations, pharmacy, dentistry and nursing. The analysis of the first questionnaire resulted in nine subjects that needed more attention in the future. Because of the low response the needs could not be specified for the individual disciplines. This insight was obtained from a second questionnaire. The response to this questionnaire was high. From the analysis of the second questionnaire differences between views of educators involved in the training of GPs and educators involved in the training of other specializations were observed. CONCLUSION: Educators find EPR-related education important. There are different opinions about the phase in which EPR-related education should be given.


Assuntos
Currículo , Sistemas Computadorizados de Registros Médicos , Inquéritos e Questionários , Docentes de Medicina , Países Baixos
20.
Emerg Med J ; 23(12): 906-10, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17130595

RESUMO

OBJECTIVE: To assess the validity of the Manchester Triage System (MTS) in paediatric emergency care, using information on vital signs, resource utilisation and hospitalisation. METHODS: Patients were eligible if they had attended the emergency department of a large inner-city hospital in The Netherlands from August 2003 to November 2004 and were <16 years of age. A representative sample of 1065 patients was drawn from 18,469 eligible patients. The originally assigned MTS urgency levels were compared with resource utilisation, hospitalisation and a predefined reference classification for true urgency, based on vital signs, resource utilisation and follow-up. Sensitivity, specificity and percentage of overtriage and undertriage of the MTS were calculated. RESULTS: The number of patients who used more than two resources increased with a higher level of MTS urgency. The percentage of hospital admissions increased with the increase in level of urgency, from 1% in the non-urgent patients to 54% in emergent patients. According to the reference classification, the sensitivity of the MTS to detect emergent/very urgent cases was 63%, and the specificity was 78%. Undertriage occurred in 15% of patients, of which 96% were by one urgency category lower than the reference classification. Overtriage occurred in 40%, mostly in lower MTS categories. In 36% of these cases, the MTS classified two or more urgency categories higher than the reference classification. CONCLUSIONS: The MTS has moderate sensitivity and specificity in paediatric emergency care. Specific modifications of the MTS should be considered in paediatric emergency care to reduce overtriage, while maintaining sensitivity in the highest urgency categories.


Assuntos
Serviços de Saúde da Criança/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Triagem/métodos , Adolescente , Criança , Pré-Escolar , Recursos em Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Países Baixos , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença
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