Abstract：
UNLABELLED:Misdiagnoses are inevitable when working hypotheses of asthma/COPD of General Practitioners (GPs) are not checked by spirometry. To reduce misdiagnoses, Asthma/COPD-support services (AC-services) offer support by performing spirometry assessed together with written medical history by consulting pulmonologists. RESEARCH QUESTIONS:Which criteria do GPs use to justify their asthma/COPD working hypotheses? How do diagnostic assessments by an AC-service change GPs' working hypotheses? Do GPs' justifications for their working hypotheses influence the extent to which working hypotheses correspond with diagnoses given by an AC-service? METHOD:We investigated the working hypotheses of 17 GPs for 284 patients with respiratory problems and their justifications: "clinical symptoms", "office spirometry", or "specialist's correspondence". Working hypotheses were compared with diagnoses given by an AC-service, and the influence of the different justifications categories on diagnostic accuracy of the working hypotheses was described. RESULTS:49% of the working hypothesis were only based on clinical information, 21% were also based on office spirometry. For 30% additional specialist information was available. 50% of the working hypotheses were confirmed by the AC-service. The working hypothesis asthma was confirmed more frequently (62%) than the working hypothesis COPD (40%). The justifications for the working hypotheses given by GPs did not influence these results. CONCLUSION:Diagnostic assessments of the AC-service differed significantly from the working hypotheses of GPs, even when these were based on previous specialists' correspondence or on office spirometry. To optimize the diagnoses in primary care, diagnostic support of an AC-service is recommended for all primary care patients with respiratory problems.
journal_name
Respir Medjournal_title
Respiratory medicineauthors
Lucas AE,Smeenk FJ,Smeele IJ,van Schayck OPdoi
10.1016/j.rmed.2012.03.002subject
Has Abstractpub_date
2012-08-01 00:00:00pages
1158-63issue
8eissn
0954-6111issn
1532-3064pii
S0954-6111(12)00087-Xjournal_volume
106pub_type
杂志文章abstract：:Patients with congestive heart failure and Cheyne-Stokes respiration have a low arterial oxygen saturation, especially during sleep, which can be increased by breathing oxygen. Chronic alterations in blood gases are known to modulate the hypercapnic ventilatory response (HCVR). We therefore evaluated whether the HCVR ...
journal_title：Respiratory medicine
pub_type： 临床试验,杂志文章,随机对照试验
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更新日期：1998-03-01 00:00:00
abstract：:In an attempt to establish the protection afforded by regular salmeterol use against induced bronchoconstriction in asthmatic patients, a meta-analysis was conducted on nine double-blind clinical trials that fulfilled the inclusion criteria. In each trial, subjects were randomly assigned to receive either salmeterol 5...
journal_title：Respiratory medicine
pub_type： 杂志文章,meta分析
doi：10.1016/s0954-6111(98)90012-9
更新日期：1998-05-01 00:00:00
abstract：BACKGROUND:We explored the prevalence, clinical and physiologic correlates of pulmonary hypertension (PH), and screening strategies in patients with severe emphysema evaluated for the National Emphysema Treatment Trial (NETT). METHODS:Patients undergoing Doppler echocardiography (DE) and right heart catheterization we...
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doi：10.1016/j.rmed.2013.11.006
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journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/s0954-6111(99)90022-7
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journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2005.12.008
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journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2014.04.007
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journal_title：Respiratory medicine
pub_type： 临床试验,杂志文章
doi：10.1016/s0954-6111(97)90253-5
更新日期：1997-08-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章,评审
doi：10.1016/j.rmed.2015.07.014
更新日期：2015-11-01 00:00:00
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pub_type： 杂志文章
doi：10.1016/j.rmed.2019.09.010
更新日期：2019-01-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章,多中心研究,随机对照试验
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更新日期：2014-08-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章,评审
doi：10.1016/j.rmed.2009.02.013
更新日期：2009-07-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2019.07.019
更新日期：2019-08-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章,多中心研究,随机对照试验
doi：10.1016/j.rmed.2008.03.009
更新日期：2008-11-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 临床试验,杂志文章,多中心研究,随机对照试验
doi：10.1016/s0954-6111(03)00162-8
更新日期：2003-10-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 临床试验,杂志文章,多中心研究
doi：10.1053/rmed.2001.1065
更新日期：2001-06-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/s0954-6111(03)00223-3
更新日期：2003-11-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2005.09.003
更新日期：2006-05-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/s0954-6111(06)80104-6
更新日期：1991-07-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2006.08.024
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journal_title：Respiratory medicine
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.rmed.2010.04.010
更新日期：2010-09-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2006.08.015
更新日期：2007-04-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2019.08.009
更新日期：2019-09-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2012.08.019
更新日期：2012-12-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章,评审
doi：10.1016/j.rmed.2003.11.008
更新日期：2004-05-01 00:00:00
abstract：OBJECTIVE:To improve physicians' ability to discriminate tuberculous from malignant pleural effusions through a simple clinical algorithm that avoids pleural biopsy. DESIGN:We retrospectively compared the clinical and pleural fluid features of 238 adults with pleural effusion who satisfied diagnostic criteria for tube...
journal_title：Respiratory medicine
pub_type： 杂志文章,多中心研究
doi：10.1016/j.rmed.2008.03.001
更新日期：2008-08-01 00:00:00
abstract：BACKGROUND:Alpha-1-antitrypsin deficiency (AATD) is significantly underdiagnosed. The early detection of AATD would enable affected persons to make lifestyle changes such as quitting smoking. It was the aim of the study to determine whether the combination of an awareness program with the offer of a cost-free diagnosti...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2007.02.024
更新日期：2007-08-01 00:00:00
abstract：BACKGROUND:Recurrent cough can be a clinical manifestation of rhinitis. However, it remains unclear if the association between rhinitis and recurrent cough among children is independent of asthma. OBJECTIVE:The aim of the present study was to determine, in a large longitudinal cohort, whether rhinitis is significantly...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2005.03.025
更新日期：2005-11-01 00:00:00
abstract：:In developing countries, many sputum-negative suspects of pulmonary tuberculosis (PTB) are given antituberculous medication just because tuberculosis (TB) could not be excluded in them. Many studies have shown that BCG test is nearly 100% sensitive, except in those with severe malnutrition, steroid therapy and other c...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1053/rmed.2003.1478
更新日期：2003-05-01 00:00:00
abstract：BACKGROUND:It has been shown that interleukin (IL)-18 levels in induced sputum are reduced in asthmatic and healthy smokers. However, in chronic obstructive pulmonary disease (COPD) patients, recent data show an overproduction in the lungs and increased serum levels of IL-18, suggesting that IL-18 may be involved in th...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2009.01.011
更新日期：2009-07-01 00:00:00
