31 research outputs found

    The effect of watchful waiting compared to immediate test ordering instructions on general practitioners' blood test ordering behaviour for patients with unexplained complaints; a randomized clinical trial (ISRCTN55755886)

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    <p>Abstract</p> <p>Background</p> <p>Immediate blood testing for patients presenting with unexplained complaints in family practice is superfluous from a diagnostic point of view. However, many general pracitioners (GPs) order tests immediately. Watchful waiting reduces the number of patients to be tested and the number of false-positive results. The objectives of this study are: to determine the feasibility of watchful waiting compared to immediate test ordering; to determine if a special quality improvement strategy can improve this feasibility; and to determine if watchful waiting leads to testing at a later time.</p> <p>Methods</p> <p>The study is a cluster-randomized clinical trial with three groups, on blood test ordering strategies in patients with unexplained complaints. GPs in group one were instructed to order tests immediately and GPs in group two to apply a watchful waiting approach. GPs in group three received the same instruction as group two, but they were supported by a systematically designed quality improvement strategy. A total of 498 patients with unexplained complaints from 63 practices of Dutch GPs participated. We measured: the percentage of patients for whom tests were ordered and number of tests ordered at the first consultation; performance on the strategy's performance objectives (i.e., ordering fewer tests and specific communication skills); the number of tests ordered after four weeks; and GP and patient characteristics.</p> <p>Results</p> <p>Immediate test ordering proved feasible in 92% of the patients; watchful waiting in 86% and 84%, respectively, for groups two and three. The two watchful waiting groups did not differ significantly in the achievement of any of the performance objectives. Of the patients who returned after four weeks, none from group one and six from the two watchful waiting groups had tests ordered for them.</p> <p>Conclusions</p> <p>Watchful waiting is a feasible approach. It does not lead to testing immediately afterwards. Furthermore, watchful waiting was not improved by the quality improvement strategy.</p> <p>Trial registration</p> <p>Clinical trial registration: <a href="http://www.controlled-trials.com/ISRCTN55755886">ISRCTN55755886</a></p

    Bedenkingen bij de ontstaansgeschiedenis van literaire teksten

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    Inleiding in de recente Nederlandse en Vlaamse prozaliteratuur

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    Item does not contain fulltextPostacademische cursus 'Recente Nederlandse en Vlaamse literatuur'Nijmege

    De calvarietocht van Maria Beert. Een lezing van Het recht van de sterkste van Cyriel Buysse

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    Item does not contain fulltextUniversiteit Gent, Vakgroep Nederlandse LiteratuurColloquium 'Cyriel Buysse en het naturalisme in de Nederlanden

    Oorlog en verraad in de roman 'Marcel' van Erwin Mortier

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    Item does not contain fulltextHet Arsenaal, NijmegenPostacademische cursus ‘Recente Nederlandse en Vlaamse literatuur

    'De initiatie van Matthieu'. Over de roman 'Koloniale waren' van Joseph Pearce

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    Item does not contain fulltextNijmegenPostacademische cursus 'Recente Nederlandse en Vlaamse literatuur

    Over het engagement van Kamiel Vanhole. Inleiding in het werk van en interview met de Vlaamse schrijver Kamiel Vanhole

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    Item does not contain fulltext18de Louis Paul BoonlezingGen
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