Background Acute gastroenteritis (AGE) affects almost all children aged ≤5 years. In secondary care, ondansetron was found to be effective at reducing vomiting. Aim To determine the effectiveness of adding oral ondansetron to care as... more
Background Acute gastroenteritis (AGE) affects almost all children aged ≤5 years. In secondary care, ondansetron was found to be effective at reducing vomiting. Aim To determine the effectiveness of adding oral ondansetron to care as usual (CAU) to treat vomiting in children with AGE attending out-ofhours primary care (OOH-PC). Design and setting A pragmatic randomised controlled trial at three OOH-PC centres in the north of the Netherlands (Groningen, Zwolle, and Assen), with a follow-up of 7 days. Method Children were included if they were: aged 6 months–6 years; AGE diagnosed by a GP; ≥4 reported episodes of vomiting in the 24 hours before presentation; ≥1 reported episode of vomiting in the 4 hours before presentation; and written informed consent from both parents. Children were randomly allocated to either the control group or the intervention group. The control group received CAU, namely oral rehydration therapy. The intervention group received CAU plus one dose of oral ondan...
Research Interests:
Background: Research in primary care is essential, but recruiting children in this setting can be complex and may cause selection bias. Challenges surrounding informed consent, particularly in an acute clinical setting, can undermine... more
Background: Research in primary care is essential, but recruiting children in this setting can be complex and may cause selection bias. Challenges surrounding informed consent, particularly in an acute clinical setting, can undermine feasibility. The off-protocol use of an intervention nearing implementation has become common in pragmatic randomized controlled trials (RCTs) set in primary care. Aim: To describe how the informed consent procedure affects study inclusion and to assess how off-protocol medication prescribing affects participant selection in a paediatric RCT. Design: A pragmatic RCT evaluating the cost-effectiveness of oral ondansetron in children diagnosed with acute gastroenteritis in primary care out-of-hours services and a parallel cohort study. Method: Consecutive children aged 6 months to 6 years attending primary care out-of-hours services with acute gastroenteritis were evaluated to assess the feasibility of obtaining informed consent, the off-protocol use of on...
BackgroundHospital admission rates are increasing for children with acute gastroenteritis. However, it is unknown whether this increase is accompanied by an increase in referral rates from GPs due to increased workloads in primary care... more
BackgroundHospital admission rates are increasing for children with acute gastroenteritis. However, it is unknown whether this increase is accompanied by an increase in referral rates from GPs due to increased workloads in primary care out-of-hours (OOH) services.AimTo assess trends in referral rates from primary care OOH services to specialist emergency care for children presenting with acute gastroenteritis.Design & settingThis retrospective cohort study covered a period from September 2007–September 2014. Children aged 6 months to 6 years presenting with acute gastroenteritis to a primary care OOH service were included.MethodPseudonymised data were obtained, and children were analysed overall and by age category. Χ2 trend tests were used to assess rates of acute gastroenteritis, referrals, face-to-face contacts, and oral rehydration therapy (ORT) prescriptions.ResultsThe data included 12 455 children (6517 boys), with a median age of 20.2 months (interquartile range [IQR] 11.6 to...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Blood markers and fecal calprotectin are used in the diagnostic workup for inflammatory bowel disease (IBD) in pediatric patients. Any added diagnostic value of these laboratory markers remains unclear. To determine whether adding... more
Blood markers and fecal calprotectin are used in the diagnostic workup for inflammatory bowel disease (IBD) in pediatric patients. Any added diagnostic value of these laboratory markers remains unclear. To determine whether adding laboratory markers to evaluation of signs and symptoms improves accuracy when diagnosing pediatric IBD. A literature search of MEDLINE and EMBASE from inception through September 26, 2016. Studies were identified using indexing terms and free-text words related to child, target condition IBD, and diagnostic accuracy. Two reviewers independently selected studies evaluating the diagnostic accuracy of more than 1 blood marker or fecal calprotectin for IBD, confirmed by endoscopy and histopathology or clinical follow-up, in pediatric patients with chronic gastrointestinal symptoms. Studies that included healthy controls and/or patients with known IBD were excluded. Individual patient data from each eligible study were requested from the authors. In addition, 2...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
ABSTRACT
Research Interests:
Research Interests:
Samenvatting Van Bergeijk H, Berger MY. Behandeling van urineweginfecties binnen en buiten praktijkuren. Huisarts Wet 2008;51(9):430-4. Inleiding Urineweginfecties (uwi’s) komen vaak voor. Tijdens werkzaamheden op een huisartsenpost viel... more
Samenvatting Van Bergeijk H, Berger MY. Behandeling van urineweginfecties binnen en buiten praktijkuren. Huisarts Wet 2008;51(9):430-4. Inleiding Urineweginfecties (uwi’s) komen vaak voor. Tijdens werkzaamheden op een huisartsenpost viel op dat er grote verschillen zijn in medicamenteus beleid bij uwi’s. Doel Met dit onderzoek willen we inzicht krijgen in de mate waarin huisartsen de richtlijnen uit de NHG-Standaard Urineweginfecties volgen. We gingen
Bij kinderen is functionele obstipatie de meest voorkomende gastro-intestinale aandoening. PEG en lactulose zijn doorgaans de laxantia die worden gebruikt. Het doel van dit artikel is weer te geven hoe een wetenschappelijk onderbouwde... more
Bij kinderen is functionele obstipatie de meest voorkomende gastro-intestinale aandoening. PEG en lactulose zijn doorgaans de laxantia die worden gebruikt. Het doel van dit artikel is weer te geven hoe een wetenschappelijk onderbouwde aanbeveling geformuleerd wordt op de vraag wat bij kinderen met functionele obstipatie de meest effectieve en veilige medicamenteuze behandeling is: PEG of lactulose? Ook wordt een, met name voor verpleegkundigen, interessante selectie van aanbevelingen uit de richtlijn ‘Obstipatie bij kinderen’ gegeven.
... Met behandelen bedoelen we het medisch of paramedisch ingrijpen. Veel men-sen trekken soms causale relaties uit het kli-nisch beloop, bijvoorbeeld: de patiënt met lage-rugklachten is beter geworden door mijn behandeling. ...
Samenvatting Het aanzien van het beroep huisarts neemt af, opleidingsplaatsen blijven leeg, prominente Nederlanders propageren dat de huisartsgeneeskunde afgeschaft kan worden en wij gingen onszelf op het NHG-congres deze week... more
Samenvatting Het aanzien van het beroep huisarts neemt af, opleidingsplaatsen blijven leeg, prominente Nederlanders propageren dat de huisartsgeneeskunde afgeschaft kan worden en wij gingen onszelf op het NHG-congres deze week ontwikkelen in onderwijs en onderzoek. Is dat geen regelrechte suïcidepoging in een tijd waarin sommigen stellen dat we de ondergang van ons vak alleen kunnen tegengaan door de patiënt en niemand
Research Interests: General Practice, Ultrasound, Prospective studies, Humans, Ultrasonography, and 15 moreFemale, Male, Netherlands, Health Status, Aged, Middle Aged, Questionnaires, Adult, Analysis of Variance, General practitioner, Cholecystectomy, Abdominal Pain, Cholelithiasis, Prospective Study, and Confidence Interval
... uitkomstmaat was de gemiddelde dagelijkse totale symptoomscore gedurende de maandenmei tot en ... Geslacht werd als niet geplande covariant toegevoegd, omdat de meis-jes:jongens-ratio na ... die niet therapietrouw waren (dat wil... more
... uitkomstmaat was de gemiddelde dagelijkse totale symptoomscore gedurende de maandenmei tot en ... Geslacht werd als niet geplande covariant toegevoegd, omdat de meis-jes:jongens-ratio na ... die niet therapietrouw waren (dat wil zeggen met een medi-catie-inname ...
Research Interests:
ABSTRACT
Research Interests:
Research Interests:
Research Interests:
- The Dutch College of General Practitioners (NHG) guideline 'Abdominal pain in children' was published in September 2012. - The guideline distinguishes between children with acute abdominal pain (≤ 1 week) and chronic abdominal... more
- The Dutch College of General Practitioners (NHG) guideline 'Abdominal pain in children' was published in September 2012. - The guideline distinguishes between children with acute abdominal pain (≤ 1 week) and chronic abdominal pain (> 1 week).- Abdominal pain can be caused by an underlying somatic condition or can have a functional nature. - The chance of finding a somatic cause is far higher in children with acute abdominal pain than in children with chronic abdominal pain. In children with acute pain the emphasis is on diagnosis, whereas in children with chronic pain it is on treatment.- Additional investigations in children without indications for a somatic cause can be limited to urinary investigation.- Most children with functional abdominal pain can be treated by their GP. This treatment consists of explanation and advice to the patient and his or her parents, with the aim of providing reassurance.- In children with continued severe functional abdominal pain, cons...
Research Interests:
In children with suspected inflammatory bowel disease, adding calprotectin stool testing to the screening strategy has been recommended to distinguish organic from non-organic disease. In this cohort study with historical controls we... more
In children with suspected inflammatory bowel disease, adding calprotectin stool testing to the screening strategy has been recommended to distinguish organic from non-organic disease. In this cohort study with historical controls we could not confirm that screening with stool calprotectin improves the diagnostic yield (ratio IBD-positive endoscopies and total number of endoscopies). However, in patients with normal fecal calprotectin levels (<50 ug/g) endoscopic and histological abnormalities were not seen. We propose to refrain from endoscopy when stool calprotectin levels are normal.
Research Interests:
Fever in children in primary care is commonly caused by benign infections, but often worries parents. Information about the duration of fever and its predictors may help in reassuring parents, leading to diminished consultation of health... more
Fever in children in primary care is commonly caused by benign infections, but often worries parents. Information about the duration of fever and its predictors may help in reassuring parents, leading to diminished consultation of health care. To determine which signs and symptoms predict a prolonged duration of fever in febrile children in primary care and evaluate whether C-reactive protein (CRP) measurement has an additive predictive value for these symptoms. A prospective cohort study at a GPs' cooperative (GPC) out-of-hours service. Children (aged 3 months to 6 years) presenting with fever as stated by the parents were included. Exclusion criteria were no communication in Dutch possible, previous enrolment in the study within 2 weeks, referral to the hospital directly after visiting the GPC, or no informed consent. The main outcome measure was prolonged duration of fever (>3 days) after initial contact. Four-hundred and eighty children were analysed, and the overall risk...
Research Interests: Primary Health Care, Parenting, Humans, Child, Female, and 15 moreMale, Infant, Netherlands, C reactive protein, Adult, Fever, Public health systems and services research, Time Factors, Prognosis, Lymphadenopathy, Predictive value of tests, Cohort Studies, Child preschool, Symptom assessment, and pharyngitis
To investigate whether sublingual immunotherapy (SLIT) in children and adolescents with house mite-induced allergic rhinitis is effective and safe. Randomised, double-blind, placebo-controlled trial. Children aged 6-18 years (n = 251)... more
To investigate whether sublingual immunotherapy (SLIT) in children and adolescents with house mite-induced allergic rhinitis is effective and safe. Randomised, double-blind, placebo-controlled trial. Children aged 6-18 years (n = 251) recruited in primary care with a house dust mite-induced allergic rhinitis received either SLIT or placebo for 2 years. Symptoms, medication use and adverse events were assessed throughout the study. The primary outcome parameter was the mean total nose symptom score (scales 0-12) during the fall after a 2-year treatment. The mean nose symptom score after 2 years of treatment showed no difference between SLIT and placebo. The mean score in the SLIT group was 2.26 (SD: 1.84) versus 2.02 in the placebo group (SD: 1.67; p = 0.08). There were no statistically significant differences in secondary outcome measures, or in subgroup analyses. The number of reported adverse events was comparable between both groups. Sublingual immunotherapy with the house-dust m...
Abstract Background For respiratory allergic disorders in children, sublingual immunotherapy has been developed as an alternative to subcutaneous immunotherapy. Sublingual immunotherapy is more convenient, has a good safety profile and... more
Abstract Background For respiratory allergic disorders in children, sublingual immunotherapy has been developed as an alternative to subcutaneous immunotherapy. Sublingual immunotherapy is more convenient, has a good safety profile and might be an attractive option for use in primary care. A randomized double-blind placebo-controlled study was designed to establish the efficacy of sublingual immunotherapy with house dust mite allergen compared to placebo treatment in 6 to18-year-old children with allergic rhinitis and a proven house dust mite allergy in primary care. Described here are the methodology, recruitment phases, and main characteristics of the recruited children. Methods Recruitment took place in September to December of 2005 and 2006. General practitioners (in south-west Netherlands) selected children who had ever been diagnosed with allergic rhinitis. Children and parents could respond to a postal invitation. Children who responded positively were screened by telephone u...
The preoperative assessment of supraclavicular lymph node metastases was prospectively studied in 100 patients with carcinoma of the esophagus and gastroesophageal junction. Findings at computed tomography (CT), ultrasound (US), and... more
The preoperative assessment of supraclavicular lymph node metastases was prospectively studied in 100 patients with carcinoma of the esophagus and gastroesophageal junction. Findings at computed tomography (CT), ultrasound (US), and palpation were compared, and US-guided fine-needle aspiration biopsy of nodes with a small axis of 5 mm or greater was performed. Supraclavicular metastases were detected on CT scans in 11 of 13 patients (85%) and on US scans in 14 of 16 patients (88%) but were palpable in only three of the 16 patients (19%). The predictive value of a supraclavicular node indicating metastases was .74 at US and .85 at CT. Metastases were diagnosed in 10 of 46 patients with squamous cell carcinoma (22%) and five of 50 patients (10%) with adenocarcinoma. Nodes with metastases had a round configuration, with a statistically significant greater short-axis to long-axis ratio than that of benign nodes (0.89 vs 0.54; P = .05). In four of 16 patients (25%) with supraclavicular metastases proved with cytologic examination, neither CT nor US of the mediastinum and abdomen showed enlarged nodes.
Research Interests:
In a small proportion of patients experiencing unspecified back pain a specified underlying pathology is present. To identify the prevalence of physician-specified causes of back pain and to assess associations between red flags and... more
In a small proportion of patients experiencing unspecified back pain a specified underlying pathology is present. To identify the prevalence of physician-specified causes of back pain and to assess associations between red flags and vertebral fractures, as diagnosed by the patients' GP, in older adults presenting with back pain in general practice. The BACE study is a prospective cohort study. Patients (aged >55 years) with back pain were included when consulting their general practitioner (GP). A questionnaire, physical examination, and heel bone densitometry were performed and determined back pain and patient characteristics, including red flags. Patients received an X-ray and reports were send to the patients' GP. The final diagnoses established at 1 year were collected from the GPs patient registry. Of the 669 patients included, 6% were diagnosed during 1 year follow-up with a serious underlying pathology. Most of these patients (n=33, 5%) were diagnosed with a verteb...
Research Interests: General Practice, Physical Therapy, Prospective studies, Humans, Back Pain, and 15 moreFemale, Male, Incidental Findings, Netherlands, Risk factors, Clinical Sciences, Aged, Prevalence, Middle Aged, Risk Factors, Pain Measurement, Predictive value of tests, Spinal fractures, Disability Evaluation, and Surveys and Questionnaires
OBJECTIVE: To compare the effectiveness of cryotherapy, salicylic acid and a wait-and-see policy in hand- and plantar warts in general practice. DESIGN: Three-armed pragmatic randomized trial (www.controlled-trials.com; ISRCTN42730629).... more
OBJECTIVE: To compare the effectiveness of cryotherapy, salicylic acid and a wait-and-see policy in hand- and plantar warts in general practice. DESIGN: Three-armed pragmatic randomized trial (www.controlled-trials.com; ISRCTN42730629). METHOD: Consecutive patients presenting for the first time with cutaneous warts were recruited from 30 Dutch general practices. We randomly allocated eligible patients to the following treatment groups: liquid-nitrogen cryotherapy every 2 weeks, daily self-application of salicylic acid, or to a wait-and-see protocol. The primary outcome measure was the percentage of patients who were cured of all warts at 13 weeks. Analysis was done on an intention to treat basis. We carried out separate subgroup analysis for common warts and plantar warts. Secondary outcomes included therapy adherence, side effects, and satisfaction with treatment. Research nurses assessed outcomes during home visits at 4, 13, and 26 weeks. RESULTS: A total of 250 patients participa...
A new payment system could curb primary health care costs. A differentiated capitation system based on patient characteristics could be the best mix for payment. To test the feasibility of such a system, we examined the number of contacts... more
A new payment system could curb primary health care costs. A differentiated capitation system based on patient characteristics could be the best mix for payment. To test the feasibility of such a system, we examined the number of contacts between patients and general practitioners (GPs), the related costs and the relationship with age, sex and comorbidity. A retrospective observational study included 29304 primary care patients in the Netherlands. Age, sex and comorbidity were related to number of contacts per patients per year and costs using a negative binomial regression analysis. Males, younger patients and patients with no comorbidities visit their GP least often. Medically unexplained physical symptoms, diabetes and severe back complaints generate the most contacts; diabetes is specifically related to higher costs. Several patient characteristics are related to the number of contacts patients have with their GP and the consecutive remuneration. This study can be used as an inp...
Research Interests:
ABSTRACT
Samenvatting Het aanzien van het beroep huisarts neemt af, opleidingsplaatsen blijven leeg, prominente Nederlanders propageren dat de huisartsgeneeskunde afgeschaft kan worden en wij gingen onszelf op het NHG-congres deze week... more
Samenvatting Het aanzien van het beroep huisarts neemt af, opleidingsplaatsen blijven leeg, prominente Nederlanders propageren dat de huisartsgeneeskunde afgeschaft kan worden en wij gingen onszelf op het NHG-congres deze week ontwikkelen in onderwijs en onderzoek. Is dat geen regelrechte suïcidepoging in een tijd waarin sommigen stellen dat we de ondergang van ons vak alleen kunnen tegengaan door de patiënt en niemand