No Relationship Between the International Prostate Symptom Score and Post-Void Residual Volume in Primary Care.

BACKGROUND: Lower urinary tract symptom (LUTS) is a common condition in older men. In accordance with the Dutch College of General Practitioners Guideline "Micturition symptoms in men", the diagnosis can be made based on a patient's medical history and a physical examination. GPs lack additional tools in primary care to assess the residual urine volume. A residual volume usually requires a referral to a urologist. We hypothesized that the IPSS screening questionnaire score (measuring the severity of symptoms) might be related to patients' residual urine volume. The research objective was to examine the relation between the IPSS score and the residual urine volume. METHODS: In a cross-sectional study, we analysed patients' IPSS and residual urine volume. Men aged over 50 with LUTS who consulted Dutch primary-care physicians were included. The interventions comprised an IPSS screening and a bladder scan. Data regarding the patients' residual volume, total IPSS score, single IPSS score, IPSS storage score, and IPSS voiding score were recorded and analysed. We used odds ratios to describe the relation between the IPSS categories associated with the presence of a normal or abnormal (above 100 cc and above 200 cc) residual urine volume. RESULTS: A total of 126 patients were included in this study. Patients with higher scores on the overall IPSS, separate IPSS, IPSS storage and IPSS voiding showed no higher odds ratios of having an abnormal residual volume, neither above 100 mL or 200 mL. CONCLUSION: We did not find a relation between the IPSS core to an abnormal residual urine volume in men aged over 50 with LUTS consulting primary-care physicians. TRIAL REGISTRATION: This study has been approved by the Central Committee on Research Involving Human Subjects for the Arnhem-Nijmegen Region and is registered with ToetsingOnline under ID number 29822.091.10.

Students' experiences with a longitudinal skills training program on breaking bad news: A follow-up study.

OBJECTIVE: Breaking bad news (BBN) should be trained, preferably early and following a helical model with multiple sessions over time, including feedback on performance. It's unclear how medical students evaluate such an approach. METHODS: We gathered student opinions regarding a helical BBN training programme, the feedback and emotional support they received, and the applicability of the skills training immediately after BBN skills training (Q1) and after finishing their clinical clerkships (Q2). RESULTS: Students find a helical curriculum useful, but this declines on follow-up. At Q2 students report less satisfaction with the amount of feedback and emotional support they received and report that the skills training was less applicable in clinical practice compared to what they reported at Q1. CONCLUSION: A helical BBN training programme with early exposure seems to lead to a shift from students being unconsciously incompetent to consciously incompetent. Students would have appreciated more emotional support and feedback. PRACTICE IMPLICATIONS: We recommend more feedback and emotional support after BBN during clerkships. The gap between classroom and practice can be diminished by emphasizing real life role play and clinical role models should demonstrate continuity and agreement between the skills that are taught and those that are used in clinical practice.

Training general practitioners in early identification and anticipatory palliative care planning: a randomized controlled trial.

BACKGROUND: Most patients with advanced cancer, debilitating COPD or chronic heart failure (CHF) live at home. General practitioners (GPs) asked for guidance in how to recognize patients in need of palliative care in a timely way and to structure anticipatory care. For that reason, we developed a training for GPs in identifying patients in need of palliative care and in structuring anticipatory palliative care planning and studied its effect on out-of-hours contacts, contacts with their own GP, hospitalizations and place of death. METHODS: We performed a cluster randomised controlled trial. GPs in the intervention group were trained in identifying patients in need of palliative care and anticipatory care planning. Next, for each identified patient, they were offered a coaching session with a specialist in palliative care to fine-tune a structured care plan. The GPs in the control group did not receive training or coaching, and were asked to provide care as usual. After one year, characteristics of patients deceased of cancer, COPD or CHF in both study groups were compared with mixed effects models for out-of-hours contacts (primary outcome), contacts with their own GP, place of death and hospitalizations in the last months of their life (secondary outcomes). As a post-hoc analysis, of identified patients (of the intervention GPs) these figures were compared to all other deceased patients, who had not been identified as in need of palliative care. RESULTS: We did not find any differences between the intervention and control group. Yet, only half of the trained GPs (28) identified patients (52), which was only 24% of the deceased patients. Those identified patients had significantly more contacts with their own GP (B 4.5218; p <0.0006), were less often hospitalized (OR 0.485; p 0.0437) more often died at home (OR 2.126; p 0.0572) and less often died in the hospital (OR 0.380; p 0.0449). CONCLUSIONS: Although we did not find differences between the intervention and control group, we found in a post-hoc analysis that those patients that had been identified as in need of palliative care had more contacts with their GP, less hospitalizations, and more often died at home. We recommend future controlled studies that try to further increase identification of patients eligible for anticipatory palliative care. The Netherlands National Trial Register: NTR2815 date 07-04-2010.

Antipsychotic drug prescription rates among Dutch nursing homes: the influence of patient characteristics and the dementia special care unit.

OBJECTIVES: To assess the differences in antipsychotic drug prescription rates in residents with dementia in dementia special care units (SCUs) of Dutch nursing homes, considering the differences in patient characteristics. METHOD: As part of the Waalbed-II study, the data on antipsychotic drug use in 290 patients were collected and the Global Deterioration Scale (GDS) stage, type of dementia and behaviour (Cohen-Mansfield Agitation Inventory (CMAI)) were measured in 14 SCUs in nine nursing homes. A multilevel logistic regression model was used to assess the difference in antipsychotic drug prescription rates between dementia SCUs adjusted for age, gender, GDS stage, type of dementia and CMAI factor scores. RESULTS: Two hundred and ninety residents met the inclusion criteria. Thirty-two per cent were prescribed an antipsychotic drug. Antipsychotic drugs were more often prescribed in patients with physically aggressive and non-aggressive behaviour and in patients with mixed dementia (vascular/Alzheimer's) than in patients with other types of dementia. Antipsychotic drug prescriptions significantly differed among the dementia SCUs. The odds of antipsychotic drug use for patients in the SCU with the highest prevalence of drug use were 2.76 (95% confidence interval (CI) 1.14-6.69) times as high as for the SCU with the lowest prevalence of drug use, taking the patient characteristics into account. CONCLUSION: Antipsychotic drug use in nursing home residents with dementia is not only predicted by the type of dementia and patient behaviour, but it is independently associated with the dementia SCU at which the patient resides. This result indicates that antipsychotic drugs are not only prescribed for their clinical indications (agitation/aggression) but are associated with environmental factors that may reflect a specific nursing home prescribing culture.

Is physician-diagnosed allergic rhinitis a risk factor for the development of asthma?

BACKGROUND: There is strong evidence that there is a relationship between allergic rhinitis (AR) and asthma, but it is unclear whether there is a causal relation between AR and asthma. The aim of this study was to assess prospectively whether AR is a risk factor for the diagnosis of asthma in a large primary care population. METHODS: We performed a historic cohort study of life-time morbidity that had been recorded prospectively since 1967 in four general practices. Two groups of subjects were selected: (i) patients with diagnosis of AR, (ii) a control group matched using propensity scores. We assessed the risk of physician-diagnosed asthma in patients with physician-diagnosed AR compared to subjects without a diagnosis of AR (controls). RESULTS: The study population consisted of 6491 subjects (n = 2081 patients with AR). Average study follow-up was 8.4 years. In patients with AR, the frequency of newly diagnosed asthma was 7.6% (n = 158) compared to 1.6% (n = 70) in controls (P < 0.001). After adjusting the effect of AR on asthma diagnosis for registration time, age, gender, eczema and socioeconomic status, having AR was a statistically significant risk factor for asthma (hazard ratio: 4.86, P < 0.001, 95% confidence interval: 3.50-6.73, controls as reference). CONCLUSION: A diagnosis of AR was an independent risk factor for asthma in our primary care study population. Having physician-diagnosed AR increased the risk almost fivefold for a future asthma diagnosis.

Gout, just a nasty event or a cardiovascular signal? A study from primary care.

OBJECTIVE: Our aim was to examine the relationship between gout on the one hand and cardiovascular diseases and cardiovascular risk indicators on the other. METHODS: A case-control study was carried out in an aggregate primary care population of approximately 12 000 patients from four Dutch general practices, with follow-up of the cases free of cardiovascular diseases at the time of the first registered episode of gout. The subjects comprised 261 patients with a first episode of gout, 170 of whom were without prevalent cardiovascular diseases, and two control patients for each case matched for age, sex and practice. In the case-control study, the main outcome measures were the prevalence of cardiovascular morbidity (angina pectoris, myocardial infarction, heart failure, cerebrovascular accident, transient ischaemic attack, peripheral vascular disease), hypertension, diabetes mellitus, obesity and hypercholesterolaemia; in the follow-up study, the main outcome measure was the incidence of cardiovascular morbidity. RESULTS: Thirty-five percent of 261 gout patients and 26% of 522 controls had one or more prevalent cardiovascular diseases. Compared with controls, patients had a higher prevalence of hypertension (43% versus 18%), hypercholesterolaemia (14% versus 6%) and obesity (56% versus 30%). A total of 170 gout patients without prevalent cardiovascular diseases (compared with 340 controls) had a higher prevalence of hypertension (39% versus 14%), hypercholesterolaemia (8% versus 4%), diabetes mellitus (5% versus 1%) and obesity (52% versus 27%). The first occurrence of a cardiovascular disease (real end-point) was seen in 26% of the patients free of cardiovascular morbidity and in 21% of the controls. This difference was not significant. In a Cox proportional hazard model, controlling for the cardiovascular risk indicators, gout did not prove to be an independent determinant for the development of cardiovascular disease. CONCLUSION: Gout was found to be associated with cardiovascular diseases and with cardiovascular risk indicators, without evidence of it being an independent risk indicator itself. A gout attack should be an incentive to assess the cardiovascular risk profile, when a patient seeks medical help.

[Nursing home rehabilitation, functional independence and quality of life: a pilot study of somatic nursing home rehabilitation patients]. / Verpleeghuisrevalidatie, functionele zelfstandigheid en kwaliteit van leven. Een pilotstudie onder somatische verpleeghuisrevalidanten.

In a pilot study of 18 patients the relation between nursing home rehabilitation, functional independence and quality of life was examined. Furthermore, measurement instruments and study design were evaluated. Nursing home rehabilitation proved to be associated with (partially significant) improvement in functional independence and quality of life. Provided the inclusion of a control group and an observation period of adequate duration, study design and measurement instruments seemed to be appropriate for application in a multicenter study.

Effect of vapor phase corrosion inhibitor on microbial corrosion of aluminum alloys.

Vapor phase corrosion inhibitors were used to investigate the antimicrobial activities and anticorrosion of aluminum alloy. Aspergillus flavus, A. niger, A. versicolor, Chaetomium globosum and Penicillium funiculosum had moderate to abundant growth on the aluminum alloy AA 1100 at Aw 0.901, while there was less growth at Aw 0.842. High humidity stimulated microbial growth and induced microbial corrosion. Dicyclohexylammonium carbonate had a high inhibitory effect on the growth of test fungi and the microbial corrosion of aluminum alloy, dicyclohexylammonium caprate and dicyclohexylammonium stearate were the next. Aluminum alloy coating with vapor phase corrosion inhibitor could prevent microbial growth and retard microbial corrosion.

Study to assess quality of life (morale and happiness) in two continuing care facilities - a comparative study in the UK and The Netherlands.

The elderly in a nursing home in Nijmegen are less disabled and have higher morale and happiness scores than the elderly in a continuing care facility in London. These scores, however, do not correlate with physical or mental disabilities within each group. In Nijmegen, religion (practising and importance of) is associated with high happiness scores in the elderly, whereas use of sedatives lead to reduced happiness or low morale in both groups of elderly.