Papers by Marie-louise Bartelink
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European Heart Journal
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Family Practice, 2015
Earlier studies have shown that clinical queries are common among doctors. Data on the informatio... more Earlier studies have shown that clinical queries are common among doctors. Data on the information-seeking behaviour of general practice (GP) trainees are scarce though, and numbers studied are small. The objective of this study was to determine how often and how GP trainees search for answers to clinical queries encountered in daily clinical practice. Third-year GP trainees kept logs on all patient contacts for eight consecutive practice days. Information was obtained on patient contacts (description), clinical queries (frequency, type), seeking behaviour (frequency, moment, reason not to search, resources used, duration of search) and answers (frequency, impact). Descriptive analyses were performed; frequencies and percentages were computed. We calculated the number of clinical queries per patient, the number of searches per query and the number of answers per search. Seventy-six trainees reported 1533 clinical queries about 7300 patients presenting 7619 complaints [mean of 0.2 queries per patient, standard deviation (SD) 0.1]. For most of the queries trainees pursued an answer (mean of 0.8 per query, SD 0.2), mostly during consultation (61% of searches), and frequently retrieved answers (mean of 0.8 per search, SD 0.17) they reported to improve clinical decision making in 26%. Most common resources were colleagues or supervisors (28%), and national GP guidelines (26%). The median duration of a search was 4 minutes (interquartile range 3). GP trainees have one clinical query per five patients. They often attempted to find answers and reported to succeed in most of the searches, primarily by consulting supervisors or colleagues and national GP guidelines.
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European Journal of Cancer, 2004
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The journal of Tehran Heart Center, 2010
An electrocardiogram (ECG) can provide information on subclinical myocardial damage. The presence... more An electrocardiogram (ECG) can provide information on subclinical myocardial damage. The presence, and more importantly, the quantity of coronary artery calcification (CAC), relates well with the overall severity of the atherosclerotic process. A strong relation has been demonstrated between coronary calcium burden and the incidence of myocardial infarction, a relation independent of age. The aim of this study was to assess the relation of left ventricular hypertrophy (LVH) and ECG abnormalities with CAC. The study population comprised 566 postmenopausal women selected from a population-based cohort study. Information on LVH and repolarization abnormalities (T-axis and QRS-T angle) was obtained using electrocardiography. Modular ECG Analysis System (MEANS) was used to assess ECG abnormalities. The women underwent a multi detector-row computed tomography (MDCT) scan (Philips Mx 8000 IDT 16) to assess CAC. The Agatston score was used to quantify CAC; scores greater than zero were cons...
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Atherosclerosis Supplements, 2011
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Atherosclerosis Supplements, 2011
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The British journal of general practice : the journal of the Royal College of General Practitioners, 2006
If a validated questionnaire, when applied to patients reporting with symptoms of intermittent cl... more If a validated questionnaire, when applied to patients reporting with symptoms of intermittent claudication, could adequately discriminate between those with and without peripheral arterial disease, GPs could avoid the diagnostic measurement of the ankle brachial index. To investigate the Edinburgh Claudication Questionnaire (ECQ) in general practice and to develop a clinical decision rule based on risk factors to enable GPs to easily assess the likelihood of peripheral arterial disease. An observational study. General practice in The Netherlands. This observational study included patients of > or =55 years visiting their GP for symptoms suggestive of intermittent claudication or with one risk factor. The ECQ and the ankle brachial index were performed. The prevalence of peripheral arterial disease, defined as an ankle brachial index <0.9, was related to risk factors using logistic regression analyses, on which a clinical decision rule was developed and related to the presence...
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Revista Española de Cardiología, 2012
... Clément , Jean-Philippe Collet , Alberto Cremonesi , Marco De Carlo , Raimund Erbel , F. Gerr... more ... Clément , Jean-Philippe Collet , Alberto Cremonesi , Marco De Carlo , Raimund Erbel , F. Gerry R. Fowkes , Magda Heras , Serge Kownator , Erich Minar , Jan Ostergren , Don Poldermans , Vincent Riambau , Marco Roffi , Joachim Röther , Horst Sievert , Marc van Sambeek y ...
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Vascular Medicine, 2007
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Vascular Health and Risk Management, 2012
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Menopause, 2008
Metabolic disturbances may explain the increased cardiovascular risk associated with reproductive... more Metabolic disturbances may explain the increased cardiovascular risk associated with reproductive factors. This cohort study investigated the relationship between reproductive factors and coronary artery calcification in elderly women and whether this relationship could be explained by metabolic disturbances. In total, 568 postmenopausal women were included in this cross-sectional study. Information about the women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s reproductive life was obtained by a questionnaire. Metabolic factors were measured during a single visit. Coronary artery calcification was assessed with a multislice computed tomography scanner and dichotomized as absent or present. Logistic regression analysis was used to assess the relationship between reproductive factors and coronary artery calcification. Crude and multivariate adjusted odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated. In addition, ORs were adjusted for several metabolic and cardiovascular risk factors. The mean age was 66.9 (+/- 5.5) years. Women with a history of irregular menstrual cycle lengths, as opposed to women with a history of regular menstrual cycles (26-30 d), had an increased risk of coronary artery calcification; multivariate-adjusted OR = 2.73 (95%CI: 1.24-5.98). Four or more pregnancies, compared with never pregnant, yielded an multivariate-adjusted OR of 1.89 (95% CI: 1.00-3.58). Having four children or more, compared with having no children, yielded a multivariate-adjusted OR of 1.97 (95% CI: 1.00-3.89). Adjustment for metabolic factors and other cardiovascular risk factors did not fully explain theses relationships. Multigravidity (more than four pregnancies), multiparity (more than four births), and irregular menstrual cycle lengths were related to an increased risk of coronary artery disease. These associations could not be explained by metabolic abnormalities.
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Menopause, 2006
Loss of ovarian function and subsequent deficiency of endogenous estrogens is suggested to enhanc... more Loss of ovarian function and subsequent deficiency of endogenous estrogens is suggested to enhance cardiovascular disease risk and related death after menopause. The aim was to obtain valid estimates of the cardiovascular disease risk associated with postmenopausal status and early menopause. A literature search of observational studies was performed using PubMed and EMBASE (1966 to May 1, 2004). Eighteen studies on postmenopausal status and age at menopause in relation to cardiovascular disease were selected. Six studies investigated menopausal status, nine studies investigated menopausal age, and three studied both. General variance-based methods were used to pool relative risk estimates and corresponding 95% confidence intervals. Stratification was performed for study design, type of menopause, outcome, and adjustment for age and smoking. The pooled relative risk estimate for postmenopausal versus premenopausal status and cardiovascular disease was 1.36 (95% CI, 1.15-1.60). In the stratified analysis, the pooled effect was 0.96 (95% CI, 0.77-1.21) after controlling for age and smoking. The pooled effect of bilateral oophorectomy on cardiovascular disease was 2.62 (95% CI, 2.05-3.35). For early menopause and cardiovascular disease, with the menopausal age category containing 50 years as a reference, the pooled relative risk estimate was 1.25 (95% CI, 1.15-1.35). In the stratified analysis, the pooled effect was 1.38 (95% CI, 1.21-1.58) after controlling for age and smoking. The pooled effect of bilateral oophorectomy on cardiovascular disease was 4.55 (95% CI, 2.56-8.01). Overall, there was no convincing relationship between postmenopausal status and cardiovascular disease. However, there was a modest effect of early menopause on cardiovascular disease. The effect was more pronounced for women with an artificial menopause than for women with a natural menopause.
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Medical Teacher, 2014
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Medical Teacher, 2013
General practitioner (GP) trainees state that their trainers are not consistent in using evidence... more General practitioner (GP) trainees state that their trainers are not consistent in using evidence-based medicine (EBM) or are even dismissive of it. As trainers are important role models in the Dutch GP training system this could have a large influence on the EBM training of GP trainees. To establish the motivations and barriers of Dutch GP trainers in using EBM. A questionnaire on personal characteristics, knowledge, skills (Berlin, score 0-15) and attitude (McColl, VAS score 0-100), and statements about EBM barriers were presented to 106 GP trainers. Additionally, three focus group sessions with trainers (n = 30) were held. Knowledge and skills were less than half correct (mean 6.1, standard deviation (SD) 2.9); the overall score on attitude was 58.8 (SD 9.4). Factor analysis showed four categories of barriers: EBM competence (mean 3.5 (SD 0.8)), search activities (mean 3.5 (SD 0.8)), motivation (mean 3.8 (SD 0.7)) and time (mean 2.5 (SD 0.9)). After analysis of the focus group sessions, five categories of motivations and barriers predominated: EBM competence, attitude and behaviour, sources, time and logistics. GP trainers experience motivations in EBM; however, these motivations can also be barriers, depending on the trainer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s level of knowledge and attitude.
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Maturitas, 2009
The protective effect of endogenous estrogens in cardiovascular disease may in part originate fro... more The protective effect of endogenous estrogens in cardiovascular disease may in part originate from effects of circulating estrogens on the electrophysiological properties of the myocardium. The aim of this study was to investigate the relation between reproductive factors and the electrocardiographic frontal T axis in postmenopausal women. Cohort study. The study was conducted at the University Medical Center Utrecht. In total, 998 postmenopausal women were included. Information of women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s reproductive life was obtained by a questionnaire. Electrocardiographic frontal T axes were categorized as normal (25-65 degrees) or abnormal (-180 degrees to 24 degrees and 66-180 degrees). Logistic regression analysis was used to assess the relationship between reproductive factors and the frontal T axis. Moreover, the effect of the lifetime cumulative number of menstrual cycles, a composite measure of all reproductive factors, on the frontal T axis was investigated. The mean age was 66.0 (+/-5.6) years and 15.3% had T-axes abnormalities. Later menopausal age decreased the risk on frontal T-axis abnormalities; the multivariable adjusted odds ratio was 0.97 (95% CI: 0.94-0.99) per year increasing menopause. For the lifetime cumulative number of menstrual cycles the age-adjusted odds ratio was 0.84 (95% CI: 0.75-0.99) per 100 menstrual cycles increase. Later age at menopause and increasing lifetime cumulative number of menstrual cycles decreased the risk on frontal T-axis changes. This supports the view that estrogens may protect against ventricular repolarization disturbances.
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Journal of Vascular Surgery, 2004
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Journal of Vascular Surgery, 2005
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Journal of Electrocardiology, 2008
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Journal of Clinical Epidemiology, 2005
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Papers by Marie-louise Bartelink