J van der Lei

Publications (61)206.59 Total impact

• Article: De invloed van computer ondersteunde besluitvorming op het aanvragen van bloedonderzoek door huisartsen

  M. A. M. Van Wijk, J van der Lei, M Mossevel, A. M. Bohnen, J. H Van Bemmel
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  ABSTRACT: Achtergrond Van verschillende methoden is het effect op het aanvraaggedrag van huisartsen aangetoond. Tot nu toe zijn deze methoden echter nooit met elkaar vergeleken door middel van gerandomiseerd onderzoek. Doel Vergelijken van het effect van twee versies van BloedLink, een elektronische beslissingsondersteunende module, op het aanvragen van bloedonderzoek door huisartsen. Methode Na stratificatie naar groepspraktijk en solopraktijk werden de beide versies gerandomiseerd verdeeld over 44 praktijken (60 huisartsen): de BloedLink-probleemgeoriënteerde module was gebaseerd op de NHG-standaarden en de BloedLink-beperkte module was gebaseerd op een tot 15 voor de huisartsenpraktijk relevante bepalingen beperkt aanvraagformulier. Het gemiddeld aantal aangevraagde bepalingen per aanvraagformulier was de belangrijkste uitkomstmaat. Resultaten Huisartsen die gebruik maakten van de BloedLink-probleemgeoriënteerde module vroegen gemiddeld 20 % minder bepalingen aan dan huisartsen die de BloedLink-beperkte module gebruikten (5.5 tests versus 6.9 tests, Mann-Whitney test p=0.003, N=44). Conclusie Beslissingsondersteuning op basis van NHG-standaarden heeft meer invloed op het aanvraaggedrag van huisartsen dan beslissingsondersteuning gebaseerd op een beperkt aanvraagformulier. Op standaarden gebaseerde beslissingsondersteunende modules kunnen een doeltreffende manier zijn om het aantal door huisartsen aangevraagde bepalingen te doen afnemen. computerondersteunde besluitvorming-kostenbeheersing-laboratorium-onderzoek-RCT
  Huisarts en wetenschap 05/2012; 44(8):388-394.
• Article: Papier of computer: het elektronisch patiëntendossier in de algemene kindergeneeskunde

  J. Roukema, R. K. Los, S. E. Bleeker, A. M. van Ginneken, J. van der Lei, H. A. Moll
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  ABSTRACT: Achtergrond: De implementatie van een elektronisch patiëntendossier (epd) lijkt grote voordelen te bieden boven het gebruik van een papieren dossier, onder meer door betere leesbaarheid, beschikbaarheid en datakwaliteit. In een epd biedt het gebruik van gestructureerde gegevensinvoer extra voordelen: controle op documentatie en juistheid van belangrijke gegevens, betere toegankelijkheid van gegevens voor naslag en mogelijkheden voor wetenschappelijk onderzoek en beslissingsondersteuning. Een generieke applicatie voor gestructureerde gegevensinvoer (Opensde) werd ontwikkeld en toegesneden op de algemene kindergeneeskunde. Doelstelling: Het evalueren van het gebruik van Opensde met betrekking tot compleetheid van het dossier, de uniformiteit in documentatie en de bruikbaarheid in de algemene kindergeneeskunde. Methoden: Vier artsen documenteerden de gegevens van acht nieuwe patiënten op de polikliniek in het gangbare papieren dossier en meteen daarna in Opensde (epd). Elk van de 32 papieren dossiers fungeerde vervolgens als databron voor gegevensinvoer in Opensde door de andere drie artsen. De gegevens uit elk papieren dossier werden ook door twee ervaren gebruikers ingevoerd in Opensde en dienden als ‘referentiedossier’. De benodigde tijd voor invoer van de gegevens werd bijgehouden en een vragenlijst werd gebruikt voor gebruikerservaringen. Resultaten: Van de beschikbare patiënteninformatie werd 44% identiek gedocumenteerd in het papieren dossier en het epd. Vijfentwintig procent werd alleen gedocumenteerd in het papieren dossier en 31% alleen in het epd. Er waren verschillen in de documentatie van anamnese en lichamelijk onderzoek (lo) in het epd: in de anamnese ontbrak meer informatie (39%) dan in het lo (15%). In het epd bevatte het lo bovendien meer extra informatie (39%) dan de anamnese (21%), ten opzichte van het papieren dossier. De interobserverovereenkomst in documentatie van dezelfde patiëntgegevens door verschillende artsen in Opensde was matig met ?=0,39 voor de anamnese en ?=0,40 voor lo. De benodigde tijd voor invoer van patiëntgegevens in Opensde nam af van 25 minuten tot minder dan 15 minuten, hetgeen duidt op een leereffect. De gebruikers waren erg positief over het gebruik van Opensde voor verslaglegging van anamnese en lo in het epd. Conclusie: Opensde lijkt een veelbelovende applicatie voor de ondersteuning van de documentatie van patiëntgegevens in de algemene kindergeneeskunde. Background: Implementation of electronic medical record systems promises significant advances in patient care, because such systems enhance readability, availability, and data quality. Structured data entry (sde) applications can prompt for completeness, provide greater accuracy and better ordering for searching and retrieval, and permit validity checks for data quality monitoring, research, and especially decision support. A generic sde application (Opensde) to support documentation of patient history and physical examination findings was developed and tailored for the domain of general pediatrics. Objective: To evaluate Opensde for its completeness, uniformity of reporting, and usability in general pediatrics. Methods: Four (trainee) pediatricians documented data for eight first-visit patients in the traditional, paper-based, medical record and immediately thereafter in Opensde (electronic record). The 32 paper records obtained served as the common data source for data entry in Opensde by the other three physicians (transcribed record). Data entered by two experienced users, with all patient information present in the paper record, served as the control record. Data entry times were recorded, and a questionnaire was used to assess users’ experiences with Opensde. Results: Clinicians documented 44% of all available patient information identically in the paper and electronic records. Twenty-five percent of all patient information was documented only in the paper record, and 31% was present only in the electronic record. Differences were found in patient history and physical examination documentation in the electronic record; more information was missing for patient history (38%) than for physical examination (15%). Furthermore, physical examination contained more additional information (39%) than did patient history (21%). The interobserver agreement of documentation of patient information from the same data source was fair to moderate, with ?=0.39 for patient history and ?=0.40 for physical examination. Data entry times in Opensde decreased from 25 minutes to <15 minutes, indicating a learning effect. The questionnaire revealed a positive attitude toward the use of Opensde in daily practice. Conclusion: Opensde seems to be a promising application for the support of physician data entry in general pediatrics.
  Tijdschrift voor kindergeneeskunde 04/2012; 75(2):54-59.
• Article: Repeatability of the Manchester Triage System for children.

  M van Veen, V F M Teunen-van der Walle, E W Steyerberg, A H J van Meurs, M Ruige, T D Strout, J van der Lei, H A Moll
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  ABSTRACT: The authors aimed to assess the repeatability of the Manchester Triage System (MTS) in children. All emergency department nurses (n=43) from a general teaching hospital and a university children's hospital in The Netherlands triaged 20 written case scenarios using the Manchester Triage system. Second, at two emergency departments (EDs), real-life simultaneous triage of patients (<16 years) was performed by ED nurses and two research nurses. The written case scenarios and the patients included in the real-life simultaneous triage study were representative of children attending the ED, in age, problem and urgency level. The authors assessed inter-rater agreement using quadratic weighted kappa values. The weighted kappa between the nurses, triaging the case scenarios, was 0.83 (95% CI 0.74 to 0.91). In total, 88% (N=198) of the eligible ED patients were triaged simultaneously, with a weighted kappa of 0.65 (95% CI 0.56 to 0.72). The MTS showed good to very good repeatability in paediatric emergency care.
  Emergency Medicine Journal 07/2010; 27(7):512-6. · 1.44 Impact Factor
• Article: Is population-oriented IT supported preventive care in general practice feasible? A database study.

  Jacobus T van Wyk, B Mosseveld, J van der Lei
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  ABSTRACT: Introducing a clinical decision support system (CDSS) in general practice that provides broad support based on all available guidelines for preventive care might dramatically increase the workload of a general practitioner. We evaluated the potential effect on workload of a CDSS that aims to support the whole breadth of preventive guidelines currently used in The Netherlands. We analysed the guidelines of the Dutch college of General Practitioners (DCGP) for preventive activities, developed a CDSS based on the guidelines and studied the behaviour of the system on real patient data. 20 of the 87 DCGP guidelines contained data on preventive activities which was incorporated in the system. Out of 485,793 patients, the system indicated that for 138,885 (28.6%) a preventive action was needed. A CDSS that aims to support the whole breadth of preventive activities in general practice will have a substantial effect on workload. Further tailoring of the support will be needed.
  Studies in health technology and informatics 01/2010; 160(Pt 1):462-5.
• Article: Problems in communication between general practitioners and internal medicine consultants

  P. J. Branger, J. C. Van Der Wouden, J. S. Duisterhout, J. Van Der Lei
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  ABSTRACT: Using a postal questionnaire, we studied the types of problems that general practitioners encounter in the communication with internal medicine consultants, and the consequences that occur as a result of these problems. Possible solutions to these problems were analysed, especially the use of electronic mail. The questionnaire was sent to 363 general practitioners in two regions in The Netherlands; replies were received from 144 (40%). Of these, 47 (33%) reported a total of 82 communication problems with the internist concerning the patient described in the most recent letter received from an internist. The most frequently reported problems were: failure of the internist to report in good time when referring the patient back to the general practitioner (15; 10%); failure of the internist to provide sufficient detail in intermediate reports (15; 10%). In 39 of 47 patients in which problems occurred, these problems led to a total of 58 consequences. The most frequently reported consequences were irritation caused to the general practitioner (15; 10%) and irritations caused to the patient (13; 9%). We conclude that communication problems mainly arise from too late delivery of information, and a lack of understanding by the internist of the information needs of the general practitioner. Personal contacts between co-treating physicians and well-established protocols are key elements in providing good cooperation between physicians. Electronic mail may be a good option to assist physicians in maintaining protocol-based communication.
  07/2009; 20(1):45-51.
• Article: An inventory of publications on electronic medical records revisited.

  P W Moorman, M J Schuemie, J van der Lei
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  ABSTRACT: In this short review we provide an update of our earlier inventories of publications indexed in MedLine with the MeSH term 'Medical Records Systems, Computerized'. We retrieved and analyzed all references to English articles published before January 1, 2008, and indexed in PubMed with the MeSH term 'Medical Records Systems, Computerized'. We retrieved a total of 11,924 publications, of which 3937 (33%) appeared in a journal with an impact factor. Since 2002 the number of yearly publications, and the number of journals in which those publications appeared, increased. A cluster analysis revealed three clusters: an organizational issues cluster, a technically oriented cluster and a cluster about order-entry and research. Although our previous inventory in 2003 suggested a constant yearly production of publications on electronic medical records since 1998, the current inventory shows another rise in production since 2002. In addition, many new journals and countries have shown interest during the last five years. In the last 15 years, interest in organizational issues remained fairly constant, order entry and research with systems gained attention, while interest in technical issues relatively decreased.
  Methods of Information in Medicine 06/2009; 48(5):454-8. · 1.53 Impact Factor
• Article: Prevalence and treatment of hypertensive patients with multiple concomitant cardiovascular risk factors in The Netherlands and Italy.

  M C J M Sturkenboom, J P Dieleman, G Picelli, G Mazzaglia, E Mozaffari, A Filippi, C Cricelli, J van der Lei
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  ABSTRACT: The Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA) trial demonstrated the benefits of combined antihypertensive/lipid-lowering treatment over antihypertensive treatment alone in hypertensive patients with > or =3 additional cardiovascular (CV) risk factors. We assessed the prevalence and treatment of patients with hypertension and > or =3 additional CV risk factors in The Netherlands and Italy in a retrospective cohort study using the Integrated Primary Care Information (IPCI) database in The Netherlands and the Health Search/Thales Database (HSD) in Italy. Patients aged > or =16 years, with 1 year of valid database history, diagnosed and/or treated for hypertension (>140/90 mmHg) during 2000-2002 were included in the study. The IPCI and HSD populations consisted of approximately 175000 and approximately 325000 patients, respectively. The prevalence of hypertension increased from 20.3 to 22.3% in the IPCI, and from 19.0 to 21.8% in the HSD during 2000-2002. The prevalence of > or =3 concomitant risk factors among hypertensive patients increased from 31.2 and 31.1% in 2000 to 34.2 and 39.3% in 2002 in the IPCI and HSD, respectively. From 2000 to 2002, among hypertensive patients with > or =3 CV risk factors and no prior symptomatic CV disease (CVD) approximately 54-57% in the IPCI and 80-83% in the HSD received antihypertensive treatment. In these patients, the use of combined antihypertensive and lipid-lowering treatment increased from 14.2 to 17.6% in the IPCI and from 15.5 to 17.4% in the HSD from 2000 to 2002. This study shows that primary prevention of CVD in hypertensive patients in The Netherlands and Italy could be improved.
  Journal of Human Hypertension 08/2008; 22(10):704-13. · 2.80 Impact Factor
• Source

  Available from: Hein Raat

  Article: Internet and written respiratory questionnaires yield equivalent results for adolescents.

  H Raat, R T Mangunkusumo, A D Mohangoo, E F Juniper, J Van Der Lei
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  ABSTRACT: This study compared results from Internet and written questionnaires about respiratory symptoms in order to find out if both forms of the survey yielded the same answers. One thousand seventy-one students, ages 13 to 17, were asked to complete either an Internet or a written questionnaire. The demographic characteristics of the participants equalled those of the general Dutch adolescent population. Participants were randomly assigned to fill out an electronic or written questionnaire. In addition to eight items from the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, two items on doctor visits (medical attention) regarding asthma or allergic disease during the past 12 months were included. The participation rate was 87%. The Internet version of the questionnaire showed fewer missing answers than the written version, but this was not statistically significant. The respiratory items did not show statistically significant score differences between the Internet and written modes of administration, and there was no visible trend for higher respectively lower scores by either mode of questionnaire administration. From these results, we conclude that respiratory questionnaires may be provided to adolescents electronically rather than on paper, since both approaches yielded equal results. To generalize these findings, we recommend repeated studies in other settings.
  Pediatric Pulmonology 05/2007; 42(4):357-61. · 2.53 Impact Factor
• Article: Internet and written respiratory questionnaires yield equivalent results for adolescents

  PhD H. Raat MD, R.T. Mangunkusumo PhD, A.D. Mohangoo Msc, E.F. Juniper, PhD J. Van Der Lei MD
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  ABSTRACT: This study compared results from Internet and written questionnaires about respiratory symptoms in order to find out if both forms of the survey yielded the same answers. One thousand seventy-one students, ages 13 to 17, were asked to complete either an Internet or a written questionnaire. The demographic characteristics of the participants equalled those of the general Dutch adolescent population. Participants were randomly assigned to fill out an electronic or written questionnaire. In addition to eight items from the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, two items on doctor visits (medical attention) regarding asthma or allergic disease during the past 12 months were included. The participation rate was 87%. The Internet version of the questionnaire showed fewer missing answers than the written version, but this was not statistically significant. The respiratory items did not show statistically significant score differences between the Internet and written modes of administration, and there was no visible trend for higher respectively lower scores by either mode of questionnaire administration. From these results, we conclude that respiratory questionnaires may be provided to adolescents electronically rather than on paper, since both approaches yielded equal results. To generalize these findings, we recommend repeated studies in other settings. Pediatr Pulmonol. 2007; 42:357–361. © 2007 Wiley-Liss, Inc.
  Pediatric Pulmonology 03/2007; 42(4):357 - 361. · 2.53 Impact Factor
• Article: Validity of the Manchester Triage System in paediatric emergency care.

  J Roukema, E W Steyerberg, A van Meurs, M Ruige, J van der Lei, H A Moll
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  ABSTRACT: To assess the validity of the Manchester Triage System (MTS) in paediatric emergency care, using information on vital signs, resource utilisation and hospitalisation. Patients were eligible if they had attended the emergency department of a large inner-city hospital in The Netherlands from August 2003 to November 2004 and were <16 years of age. A representative sample of 1065 patients was drawn from 18,469 eligible patients. The originally assigned MTS urgency levels were compared with resource utilisation, hospitalisation and a predefined reference classification for true urgency, based on vital signs, resource utilisation and follow-up. Sensitivity, specificity and percentage of overtriage and undertriage of the MTS were calculated. The number of patients who used more than two resources increased with a higher level of MTS urgency. The percentage of hospital admissions increased with the increase in level of urgency, from 1% in the non-urgent patients to 54% in emergent patients. According to the reference classification, the sensitivity of the MTS to detect emergent/very urgent cases was 63%, and the specificity was 78%. Undertriage occurred in 15% of patients, of which 96% were by one urgency category lower than the reference classification. Overtriage occurred in 40%, mostly in lower MTS categories. In 36% of these cases, the MTS classified two or more urgency categories higher than the reference classification. The MTS has moderate sensitivity and specificity in paediatric emergency care. Specific modifications of the MTS should be considered in paediatric emergency care to reduce overtriage, while maintaining sensitivity in the highest urgency categories.
  Emergency Medicine Journal 01/2007; 23(12):906-10. · 1.44 Impact Factor
• Article: EGOOZ: specifying the components of electronic patient record-related education.

  A Hasman, P Moorman, P F de Vries-Robbé, R Bindels, P Zandstra, W van Ast, J van der Lei
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  ABSTRACT: To determine whether educators consider electronic patient record (EPR)-related education necessary and if so, what subjects have to be taught more extensively in the future. A list of possibly relevant subjects was determined from the literature. A questionnaire was designed which contained those subjects and the respondents were asked to indicate, for each subject, its competency level and required competency level in current teaching. Since the response rate was low a second questionnaire was developed to have the results of the analysis of the first questionnaire validated by a larger group of educators. In total 45 learning goals were identified from the literature. The questionnaire was sent to representatives of several disciplines: basic medical education, medical specializations, pharmacy, dentistry and nursing. The analysis of the first questionnaire resulted in nine subjects that needed more attention in the future. Because of the low response the needs could not be specified for the individual disciplines. This insight was obtained from a second questionnaire. The response to this questionnaire was high. From the analysis of the second questionnaire differences between views of educators involved in the training of GPs and educators involved in the training of other specializations were observed. Educators find EPR-related education important. There are different opinions about the phase in which EPR-related education should be given.
  Methods of Information in Medicine 02/2006; 45(3):305-9. · 1.53 Impact Factor
• Article: Computed critiquing integrated into daily clinical practice affects physicians' behavior--a randomized clinical trial with AsthmaCritic.

  M M Kuilboer, M A M van Wijk, M Mosseveld, E van der Does, J C de Jongste, S E Overbeek, B Ponsioen, J van der Lei
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  ABSTRACT: We developed AsthmaCritic, a non-inquisitive critiquing system integrated with the general practitioners' electronic medical records. The system is based on the guidelines for asthma and chronic obstructive pulmonary disease (COPD) as issued by the Dutch College of General Practitioners. This paper assesses the effect of AsthmaCritic on monitoring and treatment of asthma and COPD by Dutch general practitioners in daily practice. A randomized clinical trial in 32 practices (40 Dutch general practitioners) using electronic patient records. An intervention group was given the use of AsthmaCritic, a control group continued working in the usual manner. Both groups had the disposal of the asthma and COPD guidelines routinely distributed by the Dutch College of General Practitioners. We measured the average number of contacts, FEV 1 (forced expiratory volume), and peak-flow measurements per asthma/COPD patient per practice; and, the average number of antihistamine, cromoglycate, deptropine, and oral bronchodilator prescriptions per asthma/COPD patient per practice. The number of contacts increased in the age group of 12-39 years. The number of FEV1 , peak-flow measurements, and the ratio of coded measurements increased, whereas the number of cromoglycate prescriptions decreased in the age group of 12-39 years. Our study shows that the guideline-based critiquing system AsthmaCritic changed the manner in which the physicians monitored their patients and, to a lesser extent, their treatment behavior. In addition, the physicians changed their data-recording habits.
  Methods of Information in Medicine 02/2006; 45(4):447-54. · 1.53 Impact Factor
• Article: Are structured data structured identically? Investigating the uniformity of pediatric patient data recorded using OpenSDE.

  R K Los, J Roukema, A M van Ginneken, M de Wilde, J van der Lei
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  ABSTRACT: OpenSDE is an application that supports structured recording of narrative patient data to enable use of the data in both clinical practice and clinical research. Reliability and accuracy of collected data are essential for subsequent data use. In this study we analyze the uniformity of data entered with OpenSDE. Our objective is to obtain insight into the consensus and differences of recorded data. Three pediatricians transcribed 20 paper patient records using OpenSDE. The transcribed records were compared and all recorded findings were classified into one of six categories of difference. Of all findings 22% were recorded identically; 17% of the findings were recorded differently (predominantly as free text); 61% was omitted, inferred, or in conflict with the paper record. The results of this study show that recording patient data using structured data entry does not necessarily lead to uniformly structured data.
  Methods of Information in Medicine 02/2005; 44(5):631-8. · 1.53 Impact Factor
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  Available from: cnki.net

  Article: Annual revaccination against influenza and mortality risk in community-dwelling elderly persons.

  A C G Voordouw, M C J M Sturkenboom, J P Dieleman, Th Stijnen, D J Smith, J van der Lei, Bruno H Ch Stricker
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  ABSTRACT: Although large-scale observational studies have demonstrated the effectiveness of influenza vaccination, no large studies have systematically addressed the clinical benefit of annual revaccinations. To investigate the effect of annual influenza revaccination on mortality in community-dwelling elderly persons. A population-based cohort study using the computerized Integrated Primary Care Information (IPCI) database in the Netherlands including community-dwelling individuals aged 65 years or older from 1996 through 2002. For each year, we computed the individual cumulative exposure to influenza vaccination since study start. Association between the number of consecutive influenza vaccinations and all-cause mortality vs no vaccination after adjusting for age, sex, chronic respiratory and cardiovascular disease, hypertension, diabetes mellitus, renal failure, and cancer. The study population included 26,071 individuals, of whom 3485 died during follow-up. Overall, a first vaccination was associated with a nonsignificant annual reduction of mortality risk of 10% (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.78-1.03) while revaccination was associated with a reduced mortality risk of 24% (HR, 0.76; 95% CI, 0.70-0.83). Compared with a first vaccination, revaccination was associated with a reduced annual mortality risk of 15% (HR, 0.85; 95% CI, 0.75-0.96). During the epidemic periods this reduction was 28% (HR, 0.72; 95% CI, 0.53-0.96). Similar estimates were obtained for persons with and without chronic comorbidity and those aged 70 years or older at baseline. Overall, influenza vaccination is estimated to prevent 1 death for every 302 vaccinees at a vaccination coverage that varied between 64% and 74%. Annual influenza vaccination is associated with a reduction in all-cause mortality risk in a population of community-dwelling elderly persons, particularly in older individuals.
  JAMA The Journal of the American Medical Association 12/2004; 292(17):2089-95. · 30.03 Impact Factor
• Source

  Available from: Jana Zvárová

  Article: Synergy between medical informatics and bioinformatics: facilitating genomic medicine for future health care.

  F Martin-Sanchez, I Iakovidis, S Nørager, V Maojo, P de Groen, J Van der Lei, T Jones, K Abraham-Fuchs, R Apweiler, A Babic, [......], S Orphanoudakis, N Rossing, B Sarachan, A Sousa, G Spekowius, G Thireos, G Zahlmann, J Zvárová, I Hermosilla, F J Vicente
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  ABSTRACT: In this paper, we review the results of BIOINFOMED, a study funded by the European Commission (EC) with the purpose to analyse the different issues and challenges in the area where Medical Informatics and Bioinformatics meet. Traditionally, Medical Informatics has been focused on the intersection between computer science and clinical medicine, whereas Bioinformatics have been predominantly centered on the intersection between computer science and biological research. Although researchers from both areas have occasionally collaborated, their training, objectives and interests have been quite different. The results of the Human Genome and related projects have attracted the interest of many professionals, and introduced new challenges that will transform biomedical research and health care. A characteristic of the 'post genomic' era will be to correlate essential genotypic information with expressed phenotypic information. In this context, Biomedical Informatics (BMI) has emerged to describe the technology that brings both disciplines (BI and MI) together to support genomic medicine. In recognition of the dynamic nature of BMI, institutions such as the EC have launched several initiatives in support of a research agenda, including the BIOINFOMED study.
  Journal of Biomedical Informatics 03/2004; 37(1):30-42. · 1.79 Impact Factor
• Article: The incidence of sudden cardiac death in the general population.

  S M J M Straus, G S Bleumink, J P Dieleman, J van der Lei, B H Ch Stricker, M C J M Sturkenboom
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  ABSTRACT: To determine the incidence of sudden cardiac death in a general (Dutch) population. Cohort study in the Integrated Primary Care Information (IPCI) project, a database with all medical data from 150 general practices in The Netherlands. The study population comprised 249,126 subjects with a mean follow-up of 2.54 years. In this period 4,892 deaths were identified, 582 of which were classified as (probable) sudden cardiac death. The overall incidence of sudden cardiac death in this population was 0.92 cases per 1,000 person-years (95%CI: 0.85-0.99). The risk was 2.3-fold higher in men than in women, and increased with age. The incidence of sudden cardiac death peaked in October and was lowest in August. The incidence of sudden cardiac death in the general Dutch population was almost 1 per 1,000 person-years per year during the period 1 January, 1995 to 1 April, 2001. Most of the cases occurred at home.
  Journal of Clinical Epidemiology 02/2004; 57(1):98-102. · 4.27 Impact Factor
• Article: An inventory of publications on computer-based medical records: an update.

  P W Moorman, J van der Lei
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  ABSTRACT: In 1998, we reported a steady increase in the number of publications indexed in MedLine with the MeSH term 'Medical Records Systems, Computerized'. No signs indicating an increasing interest of high-impact medical journals to publish on the computer-based patient record could be determined. In this review we provide an update. We retrieved and analyzed all English publications indexed before Feb 22, 2002 in PubMed with the MeSH term 'Medical Records Systems, Computerized'. We retrieved a total of 5856 publications, of which 1824 (31%) appeared in a journal with an impact factor in the year of publication. The total impact-score shows an upward trend. The results show that the earlier observed increase in number of publications did not persist in the second half of the nineteen-nineties. Since the mid-nineties, there has been a steady yearly production of publications indexed with the MeSH term, reflecting a sustained interest in the domain. However, the volume of publications appearing in journals with higher impact factors is increasing. Furthermore, high-impact journals, such as the "British Medical Journal", the "Lancet" and "Annals of Internal Medicine" regularly publish on the subject, reflecting an interest well beyond the medical informatics community.
  Methods of Information in Medicine 02/2003; 42(3):199-202. · 1.53 Impact Factor
• Article: Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care--the Triumph project.

  K M C Verhamme, J P Dieleman, G S Bleumink, J van der Lei, M C J M Sturkenboom, W Artibani, B Begaud, R Berges, A Borkowski, C R Chappel, [......], K MacRae, L Pientka, F F H Rutten, C P van Schayck, M J Speakman, M C Sturkenboom, P Tiellac, A Tubaro, G Vallencien, R Vela Navarrete
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  ABSTRACT: Benign prostatic hyperplasia (BPH) is one of the most common conditions associated with ageing in men. BPH often presents as lower urinary tract symptoms (LUTS) due to difficulties in voiding and irritability of the bladder. We conducted a retrospective cohort study within the Integrated Primary Care Information (IPCI) database, a general practitioners database in The Netherlands, to assess the incidence of LUTS suggestive of BPH (LUTS/BPH) in the general population. Our study population comprised all males, 45 years or older who were registered for at least 6 months prior to start of follow-up. The study period lasted from 1 January 1995 to 31 December 2000. Cases of LUTS/BPH were defined as persons with a diagnosis of BPH, treatment or surgery for BPH, or urinary symptoms suggestive of BPH that could not be explained by other co-morbidity. The study cohort comprised 80,774 males who contributed 141,035 person-years of follow-up. We identified 2181 incident and 5605 prevalent LUTS/BPH cases. The overall incidence rate of LUTS/BPH was 15 per 1000 man-years (95% CI: 14.8-16.1). The incidence increased linearly (r(2) = 0.99) with age from three cases per 1000 man-years at the age of 45-49 years (95% CI: 2.4-3.6) to a maximum of 38 cases per 1000 man-years at the age of 75-79 years (95% CI: 34.1-42.9). After the age of 80 years, the incidence rate remained constant. For a symptom-free man of 46 years, the risk to develop LUTS/BPH over the coming 30 years, if he survives, is 45%. The overall prevalence of LUTS/BPH was 10.3% (95% CI: 10.2-10.5). The prevalence rate was lowest among males 45-49 years of age (2.7%) and increased with age until a maximum at the age of 80 years (24%). The incidence rate of LUTS/BPH increases linearly with age and reaches its maximum at the age of 79 years.
  European Urology 11/2002; 42(4):323-8. · 8.49 Impact Factor
• Article: Towards personalized Internet health information: the STEPPS architecture.

  P Doupi, J van der Lei
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  ABSTRACT: STEPPS (STructured Evaluated Personalized Patient Support) proposes a strategy for integration of electronic patient records with Internet health-related content and its consequent use in personalized information retrieval for patient education. The application domain is the post-discharge support of burn patients in the Netherlands. We developed an electronic patient record interface for structured data collection in burn care. The system's thesaurus was projected to UMLS terms and the corresponding codes were incorporated in our software. A list of topics central to burn patient education was identified and a collection of related Web pages was compiled using meta-search software (Copernic2001Pro). The HTML pages were filed into catalogues by the Collexis indexing-matching software, using the UMLS Metathesaurus as indexing vocabulary. The bilingual (English and Dutch) structured data interface is currently used to create a database of retrospective patient data. Each patient's profile, i.e. set of characteristics employed to personalize information retrieval, can be automatically extracted. We have assembled a collection of more than 2500 Internet pages containing relevant information for burn patients. When patient data is available, the Collexis matching engine will accept the patient's profile as input and retrieve the most relevant HTML documents available in the catalogues. We have addressed some basic issues around the technical feasibility of linking electronic patient record data to online content. Although the functionality of STEPPS is not yet optimal, it contributes to the efforts towards improved relevance of information retrieval. Electronic patient record applications in conjunction with Internet resources can give a significant boost to the availability of tailored health education material. In this context, quality assurance of online health information is an indispensable element.
  Medical Informatics and the Internet in Medicine 10/2002; 27(3):139-51. · 1.04 Impact Factor
• Article: Incidence of acute pancreatitis.

  I A Eland, M C J M Sturkenboom, J van der Lei, J H P Wilson, B H Ch Stricker
  Scandinavian Journal of Gastroenterology 02/2002; 37(1):124. · 2.02 Impact Factor