"GOLD or lower limit of normal definition? A comparison with expert-based diagnosis of chronic obstructive pulmonary disease in a prospective cohort-study".

Background: The Global initiative for chronic Obstructive Lung Disease (GOLD) defines COPD as a fixed post-bronchodilator ratio of forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) below 0.7. Age-dependent cut-off values below the lower fifth percentile (LLN) of this ratio derived from the general population have been proposed as an alternative.

Applicability of current diagnostic algorithms in geriatric patients suspected of new, slow onset heart failure.

Background: referral for echocardiography for all geriatric outpatients suspected of heart failure (HF) is not feasible. Diagnostic algorithms could be helpful.

Objective: to investigate whether available diagnostic algorithms accurately identify (older) patients (aged 70 years or over) eligible for echocardiography, with acceptable numbers of false-negatives.

Comorbidity drives mortality in newly diagnosed heart failure: a study among geriatric outpatients.

Background: Elderly heart failure (HF) patients frequently have multiple comorbidities. The prognostic impact of combined comorbidities is poorly quantified in these patients. We assessed the impact of comorbidities on 3-year mortality in geriatric outpatients with newly diagnosed HF.

Does a decision aid help physicians to detect chronic obstructive pulmonary disease?

Background: Numerous decision aids have been developed recently, but the value they add above that of the initial clinical assessment is not well known.

Aim: To quantify whether a formal decision aid for chronic obstructive pulmonary disease (COPD) adds diagnostic information, above the physician's clinical assessment.

Design And Setting: Subanalysis of a diagnostic study in Dutch primary care.

The diagnostic value of physical examination and additional testing in primary care patients with suspected heart failure.

Background: Early diagnosis of nonacute heart failure is crucial because prompt initiation of evidence-based treatment can prevent or slow down further progression. To diagnose new-onset heart failure in primary care is challenging.

Methods And Results: This is a cross-sectional diagnostic accuracy study with external validation.

Determinants for successful marketing authorisation of orphan medicinal products in the EU.

In 2010, the European Regulation for Orphan Medicinal Products (OMPs) was in force for ten years. In this study we assessed possible determinants of applications for OMPs in the EU since 2000 that are associated with a successful marketing authorisation. Our analysis shows that clinical trial characteristics such as demonstrating convincing evidence of a beneficial effect on the primary endpoint, the selection of a clinically relevant endpoint, providing RCT data as pivotal study evidence and the submission of sound dose finding data are critical success factors.

Gender differences in pre-hospital time delay and symptom presentation in patients suspected of acute coronary syndrome in primary care.

Objective: To describe gender differences in pre-hospital delay times and symptom presentation in patients suspected of acute coronary syndrome (ACS) in a primary care setting.

Methods: Over 150 participating GPs included 298 consecutive patients suspected of ACS (52% female, mean age 66 years, 22% eventually diagnosed with ACS according to international guidelines) in a 28-month time period. Data on time from call for help until GP consultation (doctor delay) were prospectively collected, while the time from onset of symptoms until call for help (patient delay) was recorded by the GP at the time of arrival at the patient, together with patient characteristics, including age, sex, previous medical history, chest pain, radiation of chest pain and nausea/sweating.

Balance measures for propensity score methods: a clinical example on beta-agonist use and the risk of myocardial infarction.

Purpose: Propensity score (PS) methods aim to control for confounding by balancing confounders between exposed and unexposed subjects with the same PS. PS balance measures have been compared in simulated data but limited in empirical data. Our objective was to compare balance measures in clinical data and assessed the association between long-acting inhalation beta-agonist (LABA) use and myocardial infarction.

Clinical utility of three B-type natriuretic peptide assays for the initial diagnostic assessment of new slow-onset heart failure.

Background: In patients suspected of new slow-onset heart failure, data on the comparative diagnostic performance of automated B-type natriuretic peptide (BNP) assays are scarce.

Methods And Results: Two hundred patients referred to a heart failure outpatient diagnostic facility underwent standard diagnostic work-up including echocardiography. The reference standard for the diagnosis of heart failure was an expert panel conclusion.

Primary care patients with heart failure in the last year of their life.

Background: Quantitative information about the management of patients with advanced heart failure (HF) is scarce.

Objective: To assess the management of primary care patients with HF in their last year of life.

Methods: A retrospective observational study performed in 23 general practices in the Netherlands.

Selection of confounding variables should not be based on observed associations with exposure.

In observational studies, selection of confounding variables for adjustment is often based on observed baseline incomparability. The aim of this study was to evaluate this selection strategy. We used clinical data on the effects of inhaled long-acting beta-agonist (LABA) use on the risk of mortality among patients with obstructive pulmonary disease to illustrate the impact of selection of confounding variables for adjustment based on baseline comparisons.

A health insurance company-initiated practice support intervention for optimizing acid-suppressing drug prescriptions in primary care.

Background: A health insurance-initiated programme to improve cost-effectiveness of acid-suppressing drugs (ASDs).

Aim: To evaluate the effect of two different interventions of general practitioner support in reducing drug prescription.

Materials And Methods: A sequential cluster randomized controlled trial with 90 participating general practitioners in a telephone support (TS) group or practice visit (PV) group.

The importance of cardiovascular disease for mortality in patients with COPD: a prognostic cohort study.

Background: Cardiovascular diseases are the major cause of mortality in patients with chronic obstructive pulmonary disease (COPD), however, are rarely considered in prediction models in patients with COPD.

Objective: To quantify the effect of cardiovascular determinants on mortality in patients with a GP's diagnosis of COPD.

Methods: Four hundred and five patients aged ≥65 years with a diagnosis of COPD (244 with COPD by spirometry) were followed up for an average period of 4.

A comparison of subgroup analyses in grant applications and publications.

In this paper, the authors compare subgroup analyses as outlined in grant applications and their related publications. Grants awarded by the Netherlands Organization for Health Research and Development (ZonMw) from 2001 onward that were finalized before March 1, 2010, were studied. Of the 79 grant proposals, 50 (63%) were intervention studies, 18 (23%) were diagnostic studies, and 6 (8%) were prognostic studies.

Quantifying the added value of BNP in suspected heart failure in general practice: an individual patient data meta-analysis.

Background: Diagnosing early stages of heart failure with mild symptoms is difficult. B-type natriuretic peptide (BNP) has promising biochemical test characteristics, but its diagnostic yield on top of readily available diagnostic knowledge has not been sufficiently quantified in early stages of heart failure.

Objectives: To quantify the added diagnostic value of BNP for the diagnosis of heart failure in a population relevant to GPs and validate the findings in an independent primary care patient population.

[Multidisciplinary guideline 'Heart failure 2010'].

In the multidisciplinary practice guideline 'Heart failure 2010', the diagnosis of heart failure relies on a combination of signs and symptoms and on supplementary investigation with natriuretic peptides and echocardiography. Once diagnosed, it is important to detect the potentially treatable cause of the heart failure. The non-medical treatment consists of lifestyle advice, of which regular body exercise is the most important component.

Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation.

The European Society of Cardiology heart failure guidelines firmly recommend regular physical activity and structured exercise training (ET), but this recommendation is still poorly implemented in daily clinical practice outside specialized centres and in the real world of heart failure clinics. In reality, exercise intolerance can be successfully tackled by applying ET. We need to encourage the mindset that breathlessness may be evidence of signalling between the periphery and central haemodynamic performance and regular physical activity may ultimately bring about favourable changes in myocardial function, symptoms, functional capacity, and increased hospitalization-free life span and probably survival.

Clinical evaluation of geriatric outpatients with suspected heart failure: value of symptoms, signs, and additional tests.

Aims: Heart failure (HF) is common in geriatric patients. Clinicians face diagnostic challenges primarily due to comorbidity and limited access to echocardiography. The purpose of this study was to identify independent determinants of the presence of HF in geriatric outpatients and to determine the optimal diagnostic strategy.

Diagnostic value of oral prednisolone test for chronic obstructive pulmonary disorders.

Purpose: We wanted to determine the diagnostic value of an oral prednisolone test for chronic obstructive pulmonary disorders.

Methods: Two hundred thirty-three patients with cough for longer than 14 days, without known chronic obstructive pulmonary disease (COPD) or asthma, participated in a diagnostic study in Dutch primary care between 2006 and 2009. These patients used a 14-day prednisolone test of 30 mg/d and recorded before-after bronchodilator measurements of forced expiratory volume in 1 second (FEV(1)).

The furosemide diagnostic test in suspected slow-onset heart failure: popular but not useful.

Aims: Early, slow-onset heart failure is difficult to diagnose from just signs and symptoms. The physician needs ancillary diagnostic tests. The 'loop-diuretic test' or 'furosemide test', characterized as weight loss and alleviation of symptoms after a short course of a loop-diuretic, could be a candidate.

Comparing the diagnostic performance of 2 clinical decision rules to rule out deep vein thrombosis in primary care patients.

Purpose: The Wells rule is widely used for clinical assessment of patients with suspected deep vein thrombosis (DVT), especially in the secondary care setting. Recently a new clinical decision rule for primary care patients (the primary care rule) has been proposed, because the Wells rule is not sufficient to rule out DVT in this setting. The objective was to compare the ability of both rules to safely rule out DVT and to efficiently reduce the number of referrals for leg ultrasound investigation that would result in a negative finding.