A nation-wide study comparing sporadic and familial adenomatous polyposis-related desmoid-type fibromatoses.

Desmoid-type fibromatoses are neoplasms of fibroblastic origin, occurring sporadically or associated with familial adenomatous polyposis (FAP) coli. By comparing sporadic and FAP-associated desmoid-type fibromatoses, we tried to identify clinical characteristics, which may indicate FAP. Histopathology data of all Dutch patients with desmoid-type fibromatoses diagnosed between 1999 and 2009 were retrieved from PALGA, the nation-wide network and registry of histopathology in the Netherlands. For calculation of incidence rates, person-years from the general matched population were used. Based on polyp counts in pathological records, the cohort was divided into a FAP group and a non-FAP group. Patient- and tumor characteristics were compared between the two groups. A total number of 519 patients older than 10 years with a confirmed diagnosis of desmoid-type fibromatoses were included. Thirty-nine (7.5%) desmoid patients were documented of having FAP. The incidences of sporadic and FAP-related desmoid-type fibromatoses were 3.42 and 2,784 per million person-years, respectively. The majority of FAP patients developed desmoid-type fibromatoses after the diagnosis of FAP. Having FAP was associated with male gender [odds ratio (OR) 2.0, p = 0.034], desmoid diagnosis at an earlier age (mean 36 vs. 42 years, p = 0.031), and desmoid localization intra-abdominally (OR 18.9, p ≤ 0.001) or in the abdominal wall (OR 4.8, p ≤ 0.001), compared to extra-abdominal desmoid localization. In conclusion, patients with desmoid-type fibromatoses are at risk of underlying FAP. Especially cases with desmoid localization intra-abdominal or in the abdominal wall, and all patients younger than 60 years, have a substantial increased risk and should be referred for colonoscopy.

Controlled trial of effect of computer-based nutrition course on knowledge and practice of general practitioner trainees.

BACKGROUND: Nutrition education is not an integral part of either undergraduate or postgraduate medical education. Computer-based instruction on nutrition might be an attractive and appropriate tool to fill this gap. OBJECTIVE: The study objective was to assess the degree to which computer-based instruction on nutrition improves factual knowledge and practice behavior of general practitioner (GP) trainees. DESIGN: We carried out a controlled experimental study, using a 79-item knowledge test and 3 incognito standardized patients' visits in a pre- and posttest design with 49 first-year GP trainees. The experimental group (n = 25) received an average of 6 h of a newly developed computer-based instruction on nutrition. The control subjects (n = 24) took the standard vocational training program. RESULTS: The percentage of correct answers on the knowledge test increased from 30% at pretest to 42% at posttest in the experimental group, and from 36% to 37% in the control group. Analysis of covariance, with the pretest scores as covariate, showed a significant experimental versus control group difference at posttest: 9.2% (P = 0.002). The mean percentage of correctly performed items during the 3 standardized patients' visits (assessed by checklists) showed an increase in the experimental group from 20% at pretest to 36% at posttest, whereas the control group changed from 20% to 22%. Analysis of covariance, with the pretest scores as covariate, revealed a significant group difference at posttest: 13.7% (P < 0.001). CONCLUSION: The computer-based instruction proved its effectiveness, both by increasing factual knowledge and by substantially enhancing GP trainees' practice behavior on the subject of nutrition.

Monitoring of laryngopharyngeal reflux: influence of meals and beverages.

Ambulatory 24-hour double-probe pH monitoring seems to be the best test to measure reflux. Artifacts caused by intake of acid foods and beverages have to be excluded, necessitating a time-consuming manual review of the 24-hour data. Dietary restrictions used to bypass these artifacts would interfere with the normal daily life situation. Therefore, the influence of food and beverages ingested during the monitoring period was studied. Data from 252 patients who underwent double-probe pH monitoring were analyzed, first by visual inspection of the 24-hour tracing and second by leaving out the intake periods. As to the registration of gastroesophageal reflux, the inclusion or omission of meals and beverages hardly influenced the data. However, the registration of laryngopharyngeal reflux was severely biased by intake of food and beverages and other artifacts. Leaving out meals and beverages did not correct for all artifacts. Therefore, we recommend review of each laryngopharyngeal pH drop.

Fielding incognito standardised patients as 'known' patients in a controlled trial in general practice.

BACKGROUND: Incognito standardised patients (SPs) have only been used to represent new patients so far. The few trials with incognito SPs provide little detail on the method used for fielding them. OBJECTIVE: To establish the feasibility of introducing SPs as 'known' patients (i.e. patients who have previously visited the practice) into practices, to indicate the required practice preparations, and to describe the various aspects of using SPs in a pretest/post-test design. METHODS: We used incognito SPs as known patients in a controlled trial to assess the practice behaviour of 49 trainees. The SPs received a 2-day training in role playing and completing checklists. We compiled comprehensive practice information folders of each practice to be visited. Real personal data and faked medical data of SPs were inserted in the filing system of each practice to be visited. Apart from SP roles with slightly different reasons-for-encounter and different SPs, the same training protocol, checklists and practice information folders were used in the post-test. RESULTS: The SPs carried out 287 visits in 50 practices. All practices prepared the patient records for the SP visits in a fairly authentic practice style. Trainees detected the SP in 74 visits. The main reasons for detection were imperfections in patient records and aspects of SP roles or role playing. CONCLUSION: Fielding incognito SP visits as known patients was feasible but labour-intensive. Preparing the SP patient records and familiarising SPs with the interior of practices represented new elements in the use of SPs. The pretest/post-test format made their use more efficient instead of complicating it.