Papers by Bert Aertgeerts
Background: Low-back pain with leg pain (sciatica) may be caused by a herniated intervertebral di... more Background: Low-back pain with leg pain (sciatica) may be caused by a herniated intervertebral disc exerting pressure on the nerve root. Most patients will respond to conservative treatment, but in carefully selected patients, surgical discectomy may provide faster relief of symptoms. Primary care clinicians use patient history and physical examination to evaluate the likelihood of disc herniation and select patients
In many countries, questions have been raised about the use of evidence-based practice (EBP) in o... more In many countries, questions have been raised about the use of evidence-based practice (EBP) in oral health care. The call for an increase in EBP seems to face many obstacles. Only limited empirical studies address these obstacles. We present a qualitative study that explores the obstacles that Flemish (Belgian, Dutch-speaking) dentists experience in the implementation of EBP in routine clinical
BMC family practice, 2006
Information on the incidence of serious infections in children in general practice is scarce. How... more Information on the incidence of serious infections in children in general practice is scarce. However, estimates on the incidence of disease are important for several reasons, for example to assess the burden of disease or as a basis of diagnostic research. We therefore estimated the incidence of serious infections in general practice in Belgium. Intego is a morbidity registration network, in which 51 general practitioners continuously register all diagnoses and additional data in their electronic medical records. Serious infections were defined as pneumonia, sepsis, meningitis, pyelonephritis and osteomyelitis. Incidences are calculated for the period of 1998 to 2002, per 1000 patients in the yearly contact group, which is the group of patients that consulted their GP at least once that year, and in the practice population, which is the estimated true population of that practice. The incidence of all infectious diseases peaks in children between 0 and 4 years, with 1731 infections ...
BMC family practice, Jan 26, 2005
Early diagnosis of serious infections in children is difficult in general practice, as incidence ... more Early diagnosis of serious infections in children is difficult in general practice, as incidence is low, patients present themselves at an early stage of the disease and diagnostic tools are limited to signs and symptoms from observation, clinical history and physical examination. Little is known which signs and symptoms are important in general practice. With this qualitative study, we aimed to identify possible new important diagnostic variables. Semi-structured interviews with parents and physicians of children with a serious infection. We investigated all signs and symptoms that were related to or preceded the diagnosis. The analysis was done according to the grounded theory approach. Participants were recruited in general practice and at the hospital. 18 children who were hospitalised because of a serious infection were included. On average, parents and paediatricians were interviewed 3 days after admittance of the child to hospital, general practitioners between 5 and 8 days a...
International journal of nursing studies, 2014
The multiplicity and complexity of symptoms in patients treated with chemotherapy requires multif... more The multiplicity and complexity of symptoms in patients treated with chemotherapy requires multifaceted symptom management interventions. The aim of this systematic review was to describe the characteristics and evaluate the effectiveness of complex nursing interventions that target multiple symptoms in patients receiving chemotherapy. We searched Medline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials for randomized controlled trials that compared complex nursing interventions to usual care and that provided data on symptom prevalence, severity, distress or limitations. Characteristics of the interventions were described in a narrative way. Regarding the effectiveness of the interventions, ratios of means were calculated in order to present data in a comparable and clinically interpretable way. We included 11 studies, some with considerable risk of bias. Despite being heterogeneous, the interventions have patient education, symptom assessment and coaching in ...
The Journal of rheumatology, 2014
Osteoarthritis (OA) is a common cause of disability worldwide. Knee OA care is often suboptimal. ... more Osteoarthritis (OA) is a common cause of disability worldwide. Knee OA care is often suboptimal. A first necessary step in quality improvement is to gain a clear insight into usual care. We developed a set of evidence-based quality indicators for multidisciplinary high-quality knee OA care. A Rand-modified Delphi method was used to develop quality indicators for knee OA diagnosis, therapy, and followup. Recommendations were extracted from international guidelines as well as existing sets of quality indicators and scored by a multidisciplinary expert panel. Based on median score, prioritization, and agreement, recommendations were labeled as having a high, uncertain, or low potential to measure quality of care and were discussed in a consensus meeting for inclusion or exclusion. Two final validation rounds yielded a core set of recommendations, which were translated into quality indicators. From a total of 86 recommendations and existing indicators, a core set of 29 recommendations w...
Patient Education and Counseling, 2007
Objective: The project aimed to search for online evidence in a structured way in consultation wi... more Objective: The project aimed to search for online evidence in a structured way in consultation with the patient, to investigate whether the evidence discovered changed decisions. Methods: We developed the ''Online on-the-spot'' method (OOS) as a part of a quality improvement program. Within a general practice consultation three physicians and two trainees searched in a fixed pattern and sequence the national guidelines of general practitioners developed by the Dutch College of General Practitioners, Clinical Evidence, Trip-database and the British Medical Journal. All GPs who performed this quality improvement program were in favor of the project. Results: During 3 months five GPs registered 365 searches out of 2920 patient-doctor contacts. For each eight patient-doctor contacts there was one online search. Patients were actively involved in 53% of the searches (95%C.I.: 48-57%). On average, two databases were consulted. An answer to the question was found in 87% of cases and in almost half of cases it was relevant new information for the doctor. The GP changed his decision due to the problem in 26% (95%C.I.: 21-29) of cases. At the end of the OOS project, the number of searches within 5 min were significantly higher than at the start: 51% (95% C.I.: 44-59) to 33% (95% C.I.: 24-43), respectively. Conclusions: The OOS project is a timely answer to the doctors' educational needs in attending to the patient. Practice implications: OOS could connect the patient, the doctor and the evidence. #
Resuscitation, 2007
Aim: Our objectives were to determine the most effective, safe, and feasible first aid (FA) techn... more Aim: Our objectives were to determine the most effective, safe, and feasible first aid (FA) techniques and procedures, and to formulate valid recommendations for training. We focussed on emergencies involving few casualties, where emergency medical services or healthcare professionals are not immediately present at the scene, but are available within a short space of time. Due to time and resource constraints, we limited ourselves to safety, emergency removal, psychosocial FA, traumatology, and poisoning. Cardiopulmonary resuscitation (CPR) was not included because guidelines are already available from the European Resuscitation Council (ERC). The FA guidelines are intended to provide guidance to authors of FA handbooks and those responsible for FA programmes. These guidelines, together with the ERC resuscitation guidelines, will be integrated into a European FA Reference Guide and a European FA Manual. ଝ A Spanish translated version of the summary of this article appears as Appendix in the final online version at . . . ଝଝ Guidelines are not a substitute for the caregiver's own judgment of a specific medical or health condition. Casualties should consult a qualified health-care professional for advice about a specific condition. The authors disclaim any liability to any party for any damages arising out of the use or non-use of this material and any information contained therein, and all warranties, expressed or implied. RESUS-3163; No. of Pages 12 2 S. Van de Velde et al.
Primary Health Care Research & Development, 2014
Home health care today is challenged by a shift from an acute to a chronic health-care model, mov... more Home health care today is challenged by a shift from an acute to a chronic health-care model, moving the focus of care from the hospital to home-care setting. This increased focus on care at home emphasizes the need for an efficient, effective, and transparent management of home health care. However, it is not precisely known what home-care nurses do; what kind of care is received by patients; what the performance of home nurses is; and what the impact of the increasing need for home nursing is on the current and future role of home nurses. In this respect, it is necessary to gain a clear insight into the activity profile of home nurses, but there is no gold standard to measure their activities. This study reports on the development and psychometric testing of the '24-hour recall instrument for home nursing' to measure the activity profile of home nurses. Five home nurses in Belgium, simultaneously with the researcher, registered the performed activities in a total of 69 patients, using the 24-h recall instrument for home nursing. The validity and the interrater reliability of this instrument were high: the proportions that observed agreement were very high; the strength of kappa agreement was substantial to almost perfect; the prevalence index showed great variety; and the bias index was low. The findings in this study support the validity evidence based on test content and the interrater reliability of the 24-h recall instrument. This instrument can help to shape practice and policy by making the home nursing profession more transparent: a clear insight into the kind of care that is provided by home nurses and is received by the patients in primary care contributes to the development of a clear definition of the role of home nurses in health care.
Journal of Clinical Epidemiology, 2006
Background and Objective: Internal validation of a diagnostic test estimates the degree of random... more Background and Objective: Internal validation of a diagnostic test estimates the degree of random error, using the original data of a diagnostic accuracy study. External validation requires a new study in an independent but similar population. Here we describe whether diagnostic research is validated, which technique is used, and to what extent the validation study results differ from the original.
Journal of Clinical Epidemiology, 2007
be (A. Van den Bruel).
Journal of Clinical Epidemiology, 2004
To perform a meta-analysis to assess diagnostic characteristics of the CAGE in screening for alco... more To perform a meta-analysis to assess diagnostic characteristics of the CAGE in screening for alcohol abuse or dependence in a general clinical population and to test a new method for pooling of ROC curves.
Journal of Advanced Nursing, 2007
Title. Barriers to evidence-based nursing: a focus group study Aim. This paper reports a study to... more Title. Barriers to evidence-based nursing: a focus group study Aim. This paper reports a study to explore the barriers to evidence-based nursing among Flemish (Belgian) nurses. Background. Barriers obstructing the call for an increase in evidence-based nursing have been explored in many countries, mostly through quantitative study designs. Authors report on lack of time, resources, evidence, authority, support, motivation and resistance to change. Relationships between barriers are seldom presented. Methods. We used a grounded theory approach, and five focus groups were organized between September 2004 and April 2005 in Belgium. We used purposeful sampling to recruit 53 nurses working in different settings. A problem tree was developed to establish links between codes that emerged from the data. Findings. The majority of the barriers were consistent with previous findings. Flemish (Belgian) nurses added a potential lack of responsibility in the uptake of evidence-based nursing, their 'guest' position in a patient's environment leading to a culture of adaptation, and a future 'two tier' nursing practice, which refers to the different education levels of nurses. The problem tree developed serves as (1) a basic model for other researchers who want to explore barriers within their own healthcare system and (2) a useful tool for orienting change management processes. Conclusion. Despite the fact that the problem tree presented is context-specific for Flanders (Belgium), it gives an opportunity to develop clear objectives and targeted strategies for tackling obstacles to evidence-based nursing.
Journal of Adolescent Health, 2002
A large-scale study (N ؍ 3518) was designed to assess the academic performance of college fresh... more A large-scale study (N ؍ 3518) was designed to assess the academic performance of college freshmen in relationship to alcohol abuse or dependence. Alcohol abuse or dependence was identified in 501 (14%) students; of these, 128 (3.6%) were alcohol-dependent. Of the students who met criteria of alcohol dependence, 62.5% failed in their first year, compared to 50% among students who did not report these drinking problems.
International Psychogeriatrics, 2004
This issue of whether or not, how and when patients should be told of the diagnosis of dementia r... more This issue of whether or not, how and when patients should be told of the diagnosis of dementia remains a matter for discussion. Recent data confirm that the patient is told of the diagnosis in only 40 to 55% of cases. We therefore studied the performance of Flemish general practitioners (GPs) in this area. A postal questionnaire, based on that prepared by Johnson et al., was sent to a random sample of 1000 Flemish GPs, out of a total of 7000. A total of 647 answers were returned, of which 521 were eligible for analysis (response rate 60%). Thirty-six percent of these 521 GPs always or usually disclose the diagnosis, while 37% provide information about the prognosis. Most doctors (75%) see benefits in disclosure, particularly as regards planning care, providing treatment and encouraging a good doctor-patient relationship. Only 61% of respondents present an appropriate differential diagnosis. The results obtained from the Flemish GPs are similar to those of other known studies. A detailed analysis of the reasons for and the benefits of disclosing the diagnosis reveal a less reluctant attitude than could be inferred from the rough data. GPs pay a great deal of attention to the patient's feelings, experiences and ability to cope and to the proper timing of their information. However, intensive educational projects have to be set up in order to stimulate a more etiologically-oriented diagnosis and to improve the quality of the process of disclosing the diagnosis of dementia.
International Journal for Quality in Health Care, 2005
Objective. To identify a critical appraisal tool for clinical practice guidelines that could serv... more Objective. To identify a critical appraisal tool for clinical practice guidelines that could serve as a basis for the development of an appraisal tool for clinical pathways.
International Archives of Occupational and Environmental Health, 2010
Purpose To identify the attitude of occupational health physicians toward evidence-based occupati... more Purpose To identify the attitude of occupational health physicians toward evidence-based occupational health (EBOH) and clinical practice guidelines (CPGs); to determine their ability to access, retrieve and appraise the health evidence and the barriers to applying evidence to practice. Methods A cross-sectional survey study was carried out among all Dutch-speaking occupational health physicians in Belgium (584 physicians could be reached). Results A response rate of 25.5% was achieved. The majority of respondents were positive toward EBOH and CPGs. Most respondents were less conWdent in basic skills of EBM, except for their searching skills. Perceived barriers to applying evidence to practice were mainly time and lack of EBM skills. Conclusions Belgian occupational health physicians are interested in the implementation of EBOH in their daily occupational practice and have a general knowledge of EBM. However, there are barriers in the legislative framework, the education and the information infrastructure, which Wrst have to be removed. The time has come for the responsible authorities to take educational initiatives and to take a huge leap forward in the integration of EBOH into occupational practice.
Implementation Science, 2008
Background: Most quality improvement programs in diabetes care incorporate aspects of clinician e... more Background: Most quality improvement programs in diabetes care incorporate aspects of clinician education, performance feedback, patient education, care management, and diabetes care teams to support primary care physicians. Few studies have applied all of these dimensions to address clinical inertia.
Implementation Science, 2009
Electronic guideline-based decision support systems have been suggested to successfully deliver t... more Electronic guideline-based decision support systems have been suggested to successfully deliver the knowledge embedded in clinical practice guidelines. A number of studies have already shown positive findings for decision support systems such as drug-dosing systems and computer-generated reminder systems for preventive care services.
Homeopathy, 2009
Quality of life (QoL) is an important outcome measure in the treatment of seasonal allergic rhini... more Quality of life (QoL) is an important outcome measure in the treatment of seasonal allergic rhinitis (SAR), a condition for which homeopathy is frequently used. The assessment of the effect of homeopathic medical prescriptions with the Rhino-conjunctivitis Quality of Life Questionnaire (RQLQ) in the treatment of SAR. A prospective, open, non-comparative study was conducted in Belgium. Patients aged between 14 and 68 years with SAR were treated by one of seven homeopathic physicians. Patients completed the RQLQ at baseline and again after three and four weeks of homeopathic treatment. Seventy-four patients were screened, of whom 46 met the study eligibility criteria (average age 36 years, 70% female). The mean RQLQ score at baseline was 3.40 (+/-.98). After three and four weeks of homeopathic treatment it had fallen to 1.97 (+/-1.32) (P=0.0001), and 1.6 (+/-1.28) (P=0.0001), respectively. After homeopathic treatment, patients reported an alleviation of their symptoms of allergic rhinitis as reported in the RQLQ. A formal Randomized Clinical Trial (RCT) is indicated.
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Papers by Bert Aertgeerts