Ann van den Bruel

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OBJECTIVE To investigate the basis and added value of clinicians' "gut feeling" that infections in children are more serious than suggested by clinical assessment. DESIGN Observational study. SETTING Primary care setting, Flanders, Belgium. PARTICIPANTS Consecutive series of 3890 children and young people aged 0-16 years presenting in primary care. (More)
Western European health systems are not keeping pace with changes in child health needs. Non-communicable diseases are increasingly common causes of childhood illness and death. Countries are responding to changing needs by adapting child health services in different ways and useful insights can be gained through comparison, especially because some have(More)
OBJECTIVE To collate all available evidence on the diagnostic value of laboratory tests for the diagnosis of serious infections in febrile children in ambulatory settings. DESIGN Systematic review. DATA SOURCES Electronic databases, reference tracking, and consultation with experts. STUDY SELECTION Studies were selected on six criteria: design(More)
BACKGROUND Our aim was to identify which clinical features have value in confirming or excluding the possibility of serious infection in children presenting to ambulatory care settings in developed countries. METHODS In this systematic review, we searched electronic databases (Medline, Embase, DARE, CINAHL), reference lists of relevant studies, and(More)
BACKGROUND Serious infections in children (sepsis, meningitis, pneumonia, pyelonephritis, osteomyelitis, and cellulitis) are associated with considerable mortality and morbidity. In children with an acute illness, the primary care physician uses signs and symptoms to assess the probability of a serious infection and decide on further management. AIM To(More)
BACKGROUND Tiotropium is reimbursed since March 2004 in Belgium for the treatment of Chronic Obstructive Pulmonary Disease (COPD). Questions however remain on this product's value for money. The purpose of this study is to calculate tiotropium's cost-effectiveness under real-world conditions. METHODS Strengths of both observational and RCT data were(More)
OBJECTIVE Before introducing a test in clinical practice, its characteristics and added value should be assessed. Diagnostic accuracy studies only are not sufficient; the test's impact on patient outcome ought to be assessed as well. To do this, we propose a stepwise evaluation of diagnostic tests. STUDY DESIGN AND SETTING Theoretical-conceptual approach.(More)
OBJECTIVE To determine the diagnostic accuracy of ultrasound for detecting subacromial disorders in patients presenting in primary and secondary care settings. DATA SOURCES Medline and Embase were searched on June 9, 2010. In addition, the reference list of 1 systematic review and all included articles were searched to identify relevant studies. STUDY(More)
BACKGROUND Information on the incidence of serious infections in children in general practice is scarce. However, estimates on the incidence of disease are important for several reasons, for example to assess the burden of disease or as a basis of diagnostic research. We therefore estimated the incidence of serious infections in general practice in Belgium.(More)
Cost-effective health care depends on high-quality triage. The most challenging aspect of triage, which GPs confront on a regular basis, is diagnosing rare but serious disease. Failure to shoulder any risk in this situation overloads the health system and subjects patients to unnecessary investigation. Adopting too high a risk threshold leads to missed(More)