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Objective: To compare the treatment effect on lifestyle-related risk factors (LRFs) in older (≥65 years) versus younger (<65 years) patients with coronary artery disease (CAD) in The Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 (RESPONSE-2) trial.Methods: The RESPONSE-2 trial was a community-based lifestyle intervention trial (n=824) comparing nurse-coordinated referral with a comprehensive set of three lifestyle interventions (physical activity, weight reduction and/or smoking cessation) to usual care. In the current analysis, our primary outcome was the proportion of patients with improvement at 12 months follow-up (n=711) in ≥1 LRF stratified by age.Results: At baseline, older patients (n=245, mean age 69.2±3.9 years) had more adverse cardiovascular risk profiles and comorbidities than younger patients (n=579, mean age 53.7±6.6 years). There was no significant variation on the treatment effect according to age (p value treatment by age=0.45, OR 1.67, 95% CI 1.22 to 2.31). However, older patients were more likely to achieve ≥5% weight loss (OR old 5.58, 95% CI 2.77 to 11.26 vs OR young 1.57, 95% CI 0.98 to 2.49, p=0.003) and younger patients were more likely to show non-improved LRFs (OR old 0.38, 95% CI 0.22 to 0.67 vs OR young 0.88, 95% CI 0.61 to 1.26, p=0.01).Conclusion: Despite more adverse cardiovascular risk profiles and comorbidities among older patients, nurse-coordinated referral to a community-based lifestyle intervention was at least as successful in improving LRFs in older as in younger patients. Higher age alone should not be a reason to withhold lifestyle interventions in patients with CAD. [ABSTRACT FROM AUTHOR]

Objectives: Frequent attenders (FAs) suffer more and consult general practitioners (GPs) more often for chronic physical and psychiatric illnesses, social difficulties and distress than non-FAs. However, it is unclear to what extent FAs present transient episodes of care (TECs) compared with non-FAs. Design: Retrospective analysis of all episodes of care (ECs) in 15 116 consultations in 1 year. Reasons for encounter (RFEs) linked to patients' problem lists were defined as chronic ECs (CECs), other episodes as TECs. Setting: 1 Dutch urban primary healthcare centre served by 5 GPs. Participants: All 5712 adult patients were enlisted between 2007 and 2009. FAs were patients whose attendance rate ranked within the top decile of their sex and age group in at least one of the years between 2007 and 2009. Outcome measures: Number of RFEs linked to TECs/CECs for non-FAs and 1-year (1yFAs), 2-year (2yFAs) and 3-year FAs (3yFAs), and the adjusted effect of frequent attendance of different duration on the number of TECs. Results: The average number of RFEs linked to TECs (non-FAs 1.4; 3yFAs 7.3) and to CECs (non-FAs 0.9; 3yFAs 6.2) increased substantially with the duration of frequent attendance. The ratio of TECs to all ECs differed little for FAs (52-54%) and non-FAs (64%). Compared with non-FAs, the adjusted additional number of TECs was 3.4 (95% CI 3.2 to 3.7, 1yFAs), 6.6 (95% CI 6.1 to 7.0, 2yFAs) and 9.4 (95% CI 8.8 to 10.1, 3yFAs). Conclusions: FAs present more TECs and CECs with longer duration of frequent attendance. The constant ratio of TECs might be a sign of a low threshold for FAs to consult their GP. The large numbers of TECs in FAs might be associated with their high level of anxiety and low mastery. The consultation pattern of FAs may best be characterised by describing both TECs and CECs. [ABSTRACT FROM AUTHOR]

Background: Preventing exacerbations of asthma is a major goal in current guidelines. We aimed to develop a prediction model enabling practitioners to identify patients at risk of severe exacerbations who could potentially benefit from a change in management.Methods: We used data from a 12-month primary care pragmatic trial; candidate predictors were identified from GINA 2014 and selected with a multivariable bootstrapping procedure. Three models were constructed, based on: (1) history, (2) history+spirometry and (3) history+spirometry+FeNO. Final models were corrected for overoptimism by shrinking the regression coefficients; predictive performance was assessed by the area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow test. Models were externally validated in a data set including patients with severe asthma (Unbiased BIOmarkers in PREDiction of respiratory disease outcomes).Results: 80/611 (13.1%) participants experienced ≥1 severe exacerbation. Five predictors (Asthma Control Questionnaire score, current smoking, chronic sinusitis, previous hospital admission for asthma and ≥1 severe exacerbation in the previous year) were retained in the history model (AUROC 0.77 (95% CI 0.75 to 0.80); Hosmer-Lemeshow p value 0.35). Adding spirometry and FeNO subsequently improved discrimination slightly (AUROC 0.79 (95% CI 0.77 to 0.81) and 0.80 (95% CI 0.78 to 0.81), respectively). External validation yielded AUROCs of 0.69 (95% CI 0.63 to 0.75; 0.63 to 0.75 and 0.63 to 0.75) for the three models, respectively; calibration was best for the spirometry ­model.Conclusions: A simple history-based model extended with spirometry identifies patients who are prone to asthma exacerbations. The additional value of FeNO is modest. These models merit an implementation study in clinical practice to assess their utility.Trial Registration Number: NTR 1756. [ABSTRACT FROM AUTHOR]

Focuses on medical-related issues. Comparison of the total mortality between male and female doctors; Cases of insulin dependent diabetes in children; Complications of external catheters.

Objective To find an efficient set of diagnostic indicators that are optimally informative in the diagnosis of a bacterial origin of acute infectious conjunctivitis. Design Cohort study involving consecutive patients. Results of index tests and reference standard were collected independently from each other. Setting 25 Dutch health centres. Participants 184 adults presenting with a red eye and either (muco)purulent discharge or glued eyelid(s), not wearing contact lenses. Main outcome measures Probability of a positive bacterial culture,given different combinations of index test results;area under receiver operating characteristics curve. Results Logistic regression analysis showed optimal diagnostic discrimination for the combination of early morning glued eye(s),itch,and a history of conjunctivitis.The first of these indicators increased the likelihood of a bacterial cause,whereas the other two decreased it.The area under the receiver operating characteristics curve for this combination of symptoms was 0.74 (95%confidence interval 0.63 to 0.80).The overall prevalence of bacterial involvement of 32%could be lowered to 4%or raised to 77%, depending on the pattern of index test results. Conclusion A bacterial origin of complaints indicative of acute infectious conjunctivitis can be made much more likely or unlikely by the answers to three simple questions posed during clinical history taking (possibly by telephone).These results may have consequences for more targeted prescription of ocular antibiotics. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Women's Views About Management and Cause of Urinary Tract Infection: Qualitative Interview Study," by G. M. Leydon and colleagues in the February 5, 2010 issue.

The article comments on the prescription of antibiotics for conjunctivitis and upper respiratory infections. Evidence is presented from clinical trials to suggest antibiotics for the two conditions are unnecessary. Potential risks of antibiotics include drug resistance and drug side effects. The author argues that delayed prescription of antibiotics in the treatment of conjunctivitis and upper respiratory infection would cause no harm to patients in Western countries due to a low incidence of complications.

Presents the results of a placebo controlled trial of ultrasound treatment for pressure ulcers. Study of 88 patients in 12 nursing homes in the Netherlands; Problem with testing ultrasound treatment; Findings indicating the low therapeutic potential of ultrasound treatment for pressure ulcers.

Questions whether clinical signs and symptoms are useful in distinguishing between bacterial and viral acute infectious conjunctivitis. Evaluation of the diagnostic criteria offered in textbooks; Description of the literature review; Lack of evidence citing the usefulness of clinical signs and/or symptoms in diagnosis of conjunctivitis; Relevance of the study in regards to the problems of antibiotic resistance, medicalisation, and increased costs.