100 research outputs found
Hoort lumbale MRI thuis in de eerste lijn?
No full textDe Schepper E. Usefulness of lumbar MRI in general practice. Huisarts Wet 2017;60(1):21-3. General practitioners (GPs) in the Netherlands can now refer patients for MRI of the lumbar spine, but as yet there are no data on its use. For this reason, this cohort study investigated the use of lumbar MRI by Dutch GPs. One of the most striking findings was that at the time of referral most patients had had lasting symptoms and complaints for a long time. Furthermore, the MRI reports indicated that there were a relatively high number of disc pathologies. The MRI findings did not influence the GP’s decision to refer a patient to a specialist or the prognosis regarding recovery. From a clinical perspective, these results raise a number of questions about the usefulness of lumbar MRI in general practice. In order to establish whether MRI of the lumbar spine should be used as diagnostic instrument in primary care or restricted to secondary care, a well-designed randomized trial of diagnostic accuracy and cost-effectiveness is required. Until then, GPs are advised to follow the recommendations of the relevant Dutch College of General Practitioner’s guideline, which advises against diagnostic imaging in primary care
The Postgraduate Course Energy Efficiency Services: A tool to emphasis on cohesion and the dissemination of knowledge of sustainable energy consumption.
No full textThe Postgraduate Course Energy Efficiency Services: A tool to emphasis on cohesion and the dissemination of knowledge of sustainable energy consumption.
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Diagnostics in Low Back Pain
Get PDFThe aim of the work presented in this thesis is to gain more insight into the diagnostic tools used in patients with low back pain.
In recent years, general practitioners in the Netherlands can refer low back pain patients for MRI of the lumbar spine themselves. However, data on the use of MRI by general practitioners in the Netherlands are still lacking. In the first part of this thesis, we examined how lumbar MRI is currently used by general practitioners in the Netherlands.
Identifying subgroups of patients for whom different treatments are superior has been referred to as the ‘Holy Grail’ of low back pain research. One of the possible subgroups based on pathoanatomical findings are patients with degeneration of the spine. In the second part of this thesis, we performed an epidemiological study on the characteristics of lumbar disc degeneration
Anxiety problems in children and adolescents: a population-based cohort study on incidence and management in Dutch primary care
Get PDFKoet LBM, de Schepper EIT, Bohnen AM, Bindels PJE, Gerger H. Anxiety problems in children and adolescents: a population-based cohort study on incidence and management in Dutch primary care. British Journal of General Practice. 2022.Background Due to a large strain on youth mental health care, general practice is suggested as an alternative treatment setting for children and adolescents with anxiety problems. However, research on the current management of these children and adolescents within general practice is scarce. Aim To investigate the incidence of coded anxiety in general practice using the International Classification of Primary Care (ICPC), and GPs' management of children and adolescents presenting with anxiety problems. Design and setting Population-based cohort study using electronic medical records of 51 212 children (aged 0-17 years) in primary care in the Rotterdam region between 1 January 2012 and 31 December 2018. Method Incidence of ICPC codes for anxiety were calculated, then the characteristics of children and adolescents consulting their GP with anxiety and the GPs' management were assessed qualitatively using quantitative content analysis. Results Incidence of ICPC codes for anxiety in children and adolescents was 5.36 (95% confidence interval [CI] = 5.02 to 5.71) per 1000 person- years. Adolescent females had the highest incidence with 14.01 (95% CI = 12.55 to 15.58) per 1000 person-years. Of the 381 children and adolescents consulting their GP with an initial anxiety problem (median age 13.3 years, 40.4% male), GPs referred 59.3% to mental health care in the first year while 26.5% of children and adolescents were managed by a specialised practice nurse within general practice. Of the 381 children and adolescents, 10.5% received psychiatric medication during the first year, with the trend being for increased prescriptions during adolescence. Conclusion In general practice children and adolescents frequently received one of two ICPC codes for anxiety, especially adolescent females. Most presenting to their GP with anxiety problems are referred externally or seen by a specialised practice nurse within general practice
Voor de prijs van twee huizen: Vlaanderen als centrum van de middeleeuwse handschriftproductie
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