Jaap J. van Binsbergen

A prospective study on malnutrition and quality of life in patients with head and neck cancer.

The objective of this observational prospective study in patients with squamous cell carcinoma (SCC) of the oral, oropharyngeal and hypopharyngeal cavity was to look into the relation between malnutrition (>or=10% unintended weight loss within 6 months) and specific quality of life (QoL) parameters longitudinally. Bodyweight and QoL were monitored in 47 patients with SCC at diagnosis, end of treatment and six months after treatment. EORTC QoLQ-C30 and H&N 35 questionnaires were used to assess QoL. Significantly lower scores on the global QoL during treatment (p=0.01) and revalidation (p=0.02) were found for patients who had lost >or=10% compared to patients with <10% loss of weight within 6 month. Patients with radiotherapy and a treatment modality of radiotherapy with surgery or chemotherapy kept their unintended weight loss until the end of treatment. Patients with head and neck cancer treated with radiotherapy are specifically susceptible to malnutrition during treatment with no improvement in body weight or QoL. Professional preventive nutritional support is therefore already required on diagnoses.

High prevalence of undernutrition in Dutch community-dwelling older individuals

OBJECTIVE To examine the prevalence of undernutrition in community-dwelling older individuals (≥65 y) using data from various settings. METHODS A cross-sectional observational study was performed to examine the prevalence of undernutrition in three samples (all ≥65 y): 1) 1267 community-dwelling individuals participating in a large prospective population-based study, the Longitudinal Aging Study Amsterdam (LASA) in 1998/99; 2) 814 patients receiving home care in 2009/10; and 3) 1878 patients from general practices during the annual influenza vaccination in 2009/10. Undernutrition was assessed by the Short Nutritional Assessment Questionnaire 65+. RESULTS Mean age was 77.3 y (SD 6.7) in the LASA sample, 81.6 y (SD 7.4) in the home care sample, and 75.3 y (SD 6.5) in the general practice sample. The prevalence of undernutrition was highest in the home care sample (35%), followed by the general practice (12%) and LASA (11%) samples. The prevalence of undernutrition increased significantly with age in the general practice and LASA samples. Gender differences were observed in the general practice and home care samples; women were more likely to be undernourished in the general practice sample and men were more likely to be undernourished in the home care sample. CONCLUSION The prevalence of undernutrition in Dutch community-dwelling older individuals was relatively high, especially in home care patients.

Co-morbidity obese children in family practice in The Netherlands: the results of a pilot study

OBJECTIVES The aim of this pilot study was to assess the prevalence of co-morbidity in obese children. Particular emphasis was on cardiovascular risk. METHOD In this retrospective, cross-sectional, observational study the data of 155 obese children, who visited a paediatric obesity outdoor clinic, have been studied. RESULTS In all, 92% of the population had at least one cardiovascular risk factor. In all, 48% showed a high systolic and 9% a high diastolic blood pressure, while 18% had an increased fasting glucose. In 60%, we diagnosed insulin resistance: the homeostasis model assessment was elevated. DISCUSSIONS The prevalence of high blood pressure, dyslipidaemia, abnormal fasting glucose and insulin resistance are high in this retrospective study. Outcomes of foreign studies on this object are difficult to compare because various populations and cut-off points are used. A new, prospective, study will be conducted to asses the prevalence of co-morbidity in obese children in general practice.

Generalizability of systematic reviews of the effectiveness of health care interventions to primary health care: concepts, methods and future research.

BACKGROUND There is a push to make clinical decision making more evidence based and patient oriented. However, current systematic reviews are limited by the lack of consideration of generalizability. OBJECTIVE To develop a guide for investigators (systematic reviewers) on how to adapt the methodology of a systematic review to facilitate the exploration of the results to primary care. METHODS We reviewed the method guidelines of five organizations and working groups. Then, we conducted a search of literature in PubMed for articles on external validity of systematic. Based on the literature, we developed general steps to incorporate generalizability in systematic reviews and then integrated main primary care themes as outlined in WONCA definition of primary care and the definition of person-centred medicine across those steps. RESULTS We identified a wide variety of approaches to address the issue of generalizability in systematic reviews. We extracted four major primary care themes from the two definitions of primary care and person-centred medicine that we mapped across the methods of generalizability. We suggested a two-step approach: Step 1 planning the scope of a review using four-layer schematic model and Step 2 to follow four steps to incorporate the concept of generalizability to primary care in the review. CONCLUSIONS Systematic reviewers can take several steps to improve the generalizability of their review to primary care. However, more research is needed to determine which approach provides better results than others.

Patients record systems: effects on dental practice and patient oral health outcomes

This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of the review is to evaluate the impact of different patient record systems on dental practice and patient care. We would consider any comparison between different patient record systems against each other but also specifically consider the following questions: 1) Is there any measurable difference between computerized patient record systems and paper based ones? 2) Is there any measurable difference between patient held record systems and practice held ones? 3) Is there any measurable difference between multidisciplinary patient record systems (integrated medical and dental ones) and separate ones? We also intend to identify and report features of the setting that could potentially affect the impact of the intervention in a specific setting. 1 Patients record systems: effects on dental practice and patient oral health outcomes (Protocol) Copyright

Effect diëtist bij ondervoede thuiswonende ouderen

SamenvattingSchilp J, Kruizenga HM, Wijnhoven HAH, Van Binsbergen JJ, Visser M. Effect diëtist bij ondervoede thuiswonende ouderen. Huisarts Wet 2013;56(10):498-501.AchtergrondEvaluatie van de effectiviteit van de behandeling door een diëtist bij ondervoede thuiswonende ouderen.MethodeOndervoede thuiswonende ouderen (≥ 65 jaar) namen deel aan een gerandomiseerd en gecontroleerd onderzoek in de eerstelijnszorg. We randomiseerden de deelnemers naar een interventiegroep (n = 72) en een controlegroep (n = 74). De interventiegroep kreeg een verwijzing naar en behandeling door een getrainde eerstelijnsdiëtist. De controlegroep kreeg geen verwijzing en ontving de gebruikelijke zorg. Uitkomstmaten waren lichaamsgewicht, lichamelijk functioneren, handknijpkracht, energie- en eiwitinname, en vetvrije massa. Deze hebben we op baseline, en na drie en zes maanden gemeten.ResultatenNa zes maanden zagen we geen significant effect van de behandeling op de primaire uitkomstmaten lichaamsgewicht, lichamelijk functioneren en handknijpkracht. Ook was er geen effect op de secundaire uitkomstmaten.ConclusieNa zes maanden leidt een behandeling door een diëtist bij ondervoede thuiswonende ouderen niet tot een toename van lichaamsgewicht en verbetering van lichamelijk functioneren.

Te dik/overgewicht

Overgewicht en obesitas vormen een ernstige bedreiging voor de gezondheid van kinderen en zijn daarmee eigenlijk ‘kleine kwalen met grote gevolgen’. Doorgaans worden de bekende gewicht-naar-lengte-diagrammen gebruikt om een uit de hand lopend lichaamsgewicht op het spoor te komen. Deze transversale methode zegt evenwel niets over het longitudinaal bepaalde gezondheidsrisico van overgewicht en voldoet dus niet. De bij volwassenen gebruikte afkapwaarden van de body mass index (BMI) blijken bij kinderen niet zonder meer toepasbaar. Tabel 30.1 geeft de aangepaste indices voor overgewicht en obesitas bij kinderen en adolescenten.

Ondervoede oudere thuis niet gebaat bij diëtist

SamenvattingDoelEvaluatie van effectiviteit van de behandeling door een diëtist bij ondervoede thuiswonende ouderen.MethodeOndervoede thuiswonende ouderen (≥ 65 jaar) namen deel aan een gerandomiseerd en gecontroleerd onderzoek in de eerstelijnszorg. Op basis van toeval werden deelnemers ingedeeld in een interventiegroep (n = 72) en een controlegroep (n = 74). De interventiegroep werd doorverwezen en behandeld door een getrainde eerstelijnsdiëtist. De controlegroep werd niet doorverwezen naar een diëtist en ontving de gebruikelijke zorg. De belangrijkste uitkomstmaten waren lichaamsgewicht, lichamelijk functioneren en handknijpkracht. Deze hebben we aan het begin, na drie maanden en na zes maanden gemeten.ResultatenNa zes maanden zagen we geen significant effect van de behandeling op de primaire uitkomstmaten lichaamsgewicht, lichamelijk functioneren en handknijpkracht. Ook was er geen effect op andere gemeten uitkomsten, zoals energie- en eiwitinname en vetvrije massa.ConclusieNa zes maanden leidt een behandeling door een diëtist bij ondervoede thuiswonende ouderen niet tot een toename van lichaamsgewicht en verbetering van lichamelijk functioneren.

Improving nutritional management within high-risk groups

The current pitfalls and future possibilities of nutritional management are discussed by two patients with tongue cancer who have suffered from substantial weight loss. Their nutritional problems are illustrative of those among other (cancer) patient groups. The main concerns are the lack of early case finding and dietary treatment, and insufficient nutritional information transfer through referral letters. The GP as a central and longitudinal caretaker faces challenges in improving nutritional management.