Christian Melissant - Academia.edu (original) (raw)
Papers by Christian Melissant
European Respiratory Journal, Sep 1, 2012
Number: 2615 Publication Number: P724 Abstract Group: 1.6. General Practice and Primary Care
Studies in Health Technology and Informatics, 2013
In telepulmonology a general practitioner (GP) digitally consults a local pulmonologist. This stu... more In telepulmonology a general practitioner (GP) digitally consults a local pulmonologist. This study assessed the effect of telepulmonology on quality and efficiency of care. Efficiency of care was measured as the percentage of prevented physical referrals. Quality of care was measured using 5 indicators. Thirty-one percent of the TelePulmonology Consultations (TPCs) were sent to prevent a physical referral, the other TPCs were sent to ask for advice of the pulmonologist. Sixtyeight percent of the TPCs sent to prevent a physical referral indeed prevented a physical referral. Eighteen percent of the TPCs sent for advice resulted in a physical referral on advice of the pulmonologist. These patients would not have been referred without telepulmonology.
Studies in health technology and informatics, 2014
Taking and interpreting spirometry tests has proven difficult in primary care practice. This may ... more Taking and interpreting spirometry tests has proven difficult in primary care practice. This may lead to mis- or underdiagnosis of pulmonary diseases, among others chronic obstructive pulmonary disease. Telespirometry and telepulmonology consultation (TPC) may play a role in monitoring and improving the quality of the spirometry tests, supporting GPs in interpreting spirometry test results and reducing the number of physical referrals to the pulmonologist. In telespirometry up to 10% of spirometry results uploaded by GPs were randomly sent to a pulmonologist. Both the GP or practice nurse and the pulmonologist interpreted the spirometry results and gave their diagnostic findings. Additionally the pulmonologist assessed the quality of the test. In TPC a GP could digitally consult a pulmonologist for advice or referral of patients. On sending and closing the TPC consult the GP was presented a number of questions. Based on these questions the percentage of prevented physical referrals ...
Studies in health technology and informatics, 2013
In telepulmonology a general practitioner (GP) digitally consults a local pulmonologist. This stu... more In telepulmonology a general practitioner (GP) digitally consults a local pulmonologist. This study assessed the effect of telepulmonology on quality and efficiency of care. Efficiency of care was measured as the percentage of prevented physical referrals. Quality of care was measured using 5 indicators. Thirty-one percent of the TelePulmonology Consultations (TPCs) were sent to prevent a physical referral, the other TPCs were sent to ask for advice of the pulmonologist. Sixty-eight percent of the TPCs sent to prevent a physical referral indeed prevented a physical referral. Eighteen percent of the TPCs sent for advice resulted in a physical referral on advice of the pulmonologist. These patients would not have been referred without telepulmonology.
Respiratory Medicine, 2014
Background: Interpreting spirometry results has proven challenging in primary care practice, amon... more Background: Interpreting spirometry results has proven challenging in primary care practice, among others potentially leading to under-and misdiagnosis of COPD. In telepulmonology a general practitioner (GP) digitally consults a pulmonologist to support the interpretation of spirometry results. This study assessed the effect of telepulmonology on quality and efficiency of care. Methods: Quality of care was measured by five indicators, among others the percentage of Tel-ePulmonology Consultations (TPCs) sent by GPs for advice, percentage of those TPCs resulting in a physical referral, and educational effect of telepulmonology as experienced by GPs. Efficiency was defined as the percentage of prevented unnecessary physical referrals of patients to the pulmonologist. Results: Between April 2009 and November 2012 1.958 TPCs were sent by 158 GPs to 32 pulmonologists. Sixty-nine percent of the TPCs were sent for advice. Based on the advice of the pulmonologist 18% of these TPCs led to a physical referral of patients who would not have been referred without telepulmonology. Thirty-one percent of the TPCs were intended to prevent a physical referral, 68% of these actually prevented a physical referral to a pulmonologist.
European Respiratory Journal, 1998
The relationship between the abnormalities in the different routine lung function tests and the d... more The relationship between the abnormalities in the different routine lung function tests and the degree of functional limitation during exercise is not well established in upper airway obstruction (UAO). On the contrary, in chronic obstructive pulmonary disease (COPD), for instance, a forced expiratory volume in one second (FEV1) of 60% predicted is generally associated with a peak expiratory flow (PEF) of 60-70% pred and corresponds with a moderate physical impairment of ~20-30% [1, 2]. Yet, in UAO, FEV1 will still be 70-80% pred when PEF is only 40-50% pred and it is not established what the clinical relevance is of each of these changes in terms of exercise limitation, although it is generally accepted that FEV1 is an insensitive test for UAO .
CHEST Journal, 1991
can be found online on the World Wide Web at:
American Journal of Respiratory and Critical Care Medicine, 1995
A fixed orifice or a fixed upper airway obstruction (UAO) causes an expiratory and inspiratory pl... more A fixed orifice or a fixed upper airway obstruction (UAO) causes an expiratory and inspiratory plateau-shaped limitation on maximal flow-volume (MEFV, MIFV) curves and, according to the classic concept, a MEF50/MIF50 ratio of 0.9-1.1. However, since maximal expiratory static transrespiratory pressures (PEmax,stat) are clearly greater than the inspiratory ones (PImax,stat), the pressures applied during forced expiration also must be expected to be greater than inspiratory pressures; therefore, the MEF should be larger than the MIF because orifice flow is effort-dependent. We investigated this hypothesis in seven healthy, nonsmoking male volunteers (mean age +/- 1 SD: 34 +/- 10 yr, FVC: 5.9 +/- 1.0 L, PEmax,stat: 168 +/- 16 cm H2O, PImax,stat: 107 +/- 33 cm H2O). They performed MEFV curves and MIFV curves through four different added resistances placed in between the pneumotachograph and the mouth (the orifice diameters ranged between 7.8 mm and 2.8 mm). During these maneuvers dynamic mouth pressures were also measured (PE and PI). We found that the MEF50/MIF50 ratios were significantly increased (p < 0.05) from a control value of 1.1 +/- 0.4 up to 1.5 +/- 0.3 with the resistances. For each added resistance the PE/MEF ratios and (-)PI/MIF ratios were situated on a single line corresponding with the pressure-flow (P/V) characteristics of the resistance. We concluded that external resistances cause a MEF50/MIF50 ratio of clearly more than 1 and that this is determined by the PE/(-)PI ratio, which in healthy subjects is markedly larger than 1.
European Respiratory Journal, Sep 1, 2011
Chest Journal, Feb 1, 1993
prednisone. sarcoidosis. Favorable effect of propranolol and Bleeding varices due to portal hyper... more prednisone. sarcoidosis. Favorable effect of propranolol and Bleeding varices due to portal hypertension in http://chestjournal.chestpubs.org/content/103/2/628 can be found online on the World Wide Web at: The online version of this article, along with updated information and services ) ISSN:0012-3692 http://chestjournal.chestpubs.org/site/misc/reprints.xhtml A 58-year-old white man had bleeding varices in the gastric fundus due to portal hypertension attributable to histologically proven hepatic sarcoid involvement with a giant splenomegaly and with an angiographically demonstrated significant flow toward the liver. Treatment with corticosteroids and beta-blockade (30 mg propranolol daily) resulted in no rebleeding for over one year follow-up (Chest 1993; 103:628-29)
Nederlands tijdschrift voor geneeskunde, Jan 18, 1992
We report a 27-year-old man, who became comatose after autopoisoning with a high dose of valnocta... more We report a 27-year-old man, who became comatose after autopoisoning with a high dose of valnoctamide. He was mechanically ventilated for 12 hours and survived without serious side effects. Valnoctamide blood levels were monitored in order to study the pharmacokinetics of oral overdosing of this drug. Serum half-time levels appeared to be approximately 15 hours.
Acta oto-rhino-laryngologica Belgica, 1995
Few data are available on the relative sensitivity of different lung function tests in upper airw... more Few data are available on the relative sensitivity of different lung function tests in upper airway obstruction (UAO) and on the correlation of these tests with radiological estimations of tracheal stenosis. This paper is based on patients with a goiter or tracheal tumor and in healthy subjects breathing through rigid resistors, as well as on literature data. Lung function abnormalities present a specific pattern in UAO: this is characterised by a typical shape of the maximal flow-volume curve, a marked reduction in peakflow (PEF) and only minor changes in routine spirometry (e.g. FEV1, which thus tends to underestimate the stenosis). The clinical relevance of the lung function abnormalities in UAO can be estimated from their relationship with the exercise limitation: a moderate exercise limitation to about 60% pred is found if PEF is reduced to about 40% pred, and Raw is increased to about 600% pred (in which instance FEV1 is still 75% pred). This limitation grossly corresponds to ...
The Netherlands journal of medicine, 1992
We report a male Caucasian, with a Dengue virus infection imported from Thailand to The Netherlan... more We report a male Caucasian, with a Dengue virus infection imported from Thailand to The Netherlands. General characteristics of the disease are presented and the supposed pathogenetic mechanisms of the disease are discussed.
C52. BACTERIAL PNEUMONIA: TREATMENT, 2010
Netherlands Heart Journal, 2008
We describe a patient who developed generalised pruritis with oedema and rash two weeks after she... more We describe a patient who developed generalised pruritis with oedema and rash two weeks after she had started taking clopidogrel following coronary stent implantation. In the absence of other likely causative agents, clopidogrel hypersensitivity was probable. She was treated with a rapid oral desensitisation procedure, after which a daily dose of 75 mg clopidogrel was well tolerated. No major adverse events occurred during a follow-up period of eight months. Oral desensitisation in clopidogrel hypersensitivity seems to be a safe method to reduce the risk of coronary stent thrombosis. (Neth Heart J 2008;16:21-3).
Respiratory Medicine CME, 2010
Severe hypothyroidism is associated with a wide spectrum of pulmonary and cardiovascular disorder... more Severe hypothyroidism is associated with a wide spectrum of pulmonary and cardiovascular disorders. However, it rarely presents with pleural effusion. A 57-year-old woman presented with a stroke and leftsided pleural effusion was suspected of having hypertensive cardiomyopathy. During the treatment with diuretics, her renal function deteriorated and she developed a complete respiratory insufficiency, which led us to the definitive diagnosis. Therapy with thyroid hormone resulted in significant clinical improvement and the pleural effusion disappeared. Myxedema is easily missed when myxedema and pitting edema are simultaneously present in one subject. Severe hypothyroidism should be considered in the differential diagnosis of unexplained pleural effusion.
European Respiratory Journal, 1994
L Lu un ng g f fu un nc ct ti io on n, , C CT T--s sc ca an n a an nd d X X--r ra ay y i in n u u... more L Lu un ng g f fu un nc ct ti io on n, , C CT T--s sc ca an n a an nd d X X--r ra ay y i in n u up pp pe er r a ai ir rw wa ay y o ob bs st tr ru uc ct ti io on n d du ue e t to o t th hy yr ro oi id d g go oi it tr re e Lung function, CT-scan and X-ray in upper airway obstruction due to thyroid goitre. ABSTRACT: The purpose of this study was to assess the clinical reliability and to compare routine lung function tests (maximal flows and resistance) and radiological images (computed tomography (CT)-scan and X-ray) in upper airway obstruction. We, therefore, performed these examinations prospectively in 28 female patients (aged 68±13 yrs) with a goitre and without pulmonary disorders. Lung function measurements consisted of maximum expiratory and inspiratory flow-volume curves and of airway resistance. CT-scans and X-rays were performed during apnoea at functional residual capacity (FRC).
European Respiratory Journal, Sep 1, 2012
Number: 2615 Publication Number: P724 Abstract Group: 1.6. General Practice and Primary Care
Studies in Health Technology and Informatics, 2013
In telepulmonology a general practitioner (GP) digitally consults a local pulmonologist. This stu... more In telepulmonology a general practitioner (GP) digitally consults a local pulmonologist. This study assessed the effect of telepulmonology on quality and efficiency of care. Efficiency of care was measured as the percentage of prevented physical referrals. Quality of care was measured using 5 indicators. Thirty-one percent of the TelePulmonology Consultations (TPCs) were sent to prevent a physical referral, the other TPCs were sent to ask for advice of the pulmonologist. Sixtyeight percent of the TPCs sent to prevent a physical referral indeed prevented a physical referral. Eighteen percent of the TPCs sent for advice resulted in a physical referral on advice of the pulmonologist. These patients would not have been referred without telepulmonology.
Studies in health technology and informatics, 2014
Taking and interpreting spirometry tests has proven difficult in primary care practice. This may ... more Taking and interpreting spirometry tests has proven difficult in primary care practice. This may lead to mis- or underdiagnosis of pulmonary diseases, among others chronic obstructive pulmonary disease. Telespirometry and telepulmonology consultation (TPC) may play a role in monitoring and improving the quality of the spirometry tests, supporting GPs in interpreting spirometry test results and reducing the number of physical referrals to the pulmonologist. In telespirometry up to 10% of spirometry results uploaded by GPs were randomly sent to a pulmonologist. Both the GP or practice nurse and the pulmonologist interpreted the spirometry results and gave their diagnostic findings. Additionally the pulmonologist assessed the quality of the test. In TPC a GP could digitally consult a pulmonologist for advice or referral of patients. On sending and closing the TPC consult the GP was presented a number of questions. Based on these questions the percentage of prevented physical referrals ...
Studies in health technology and informatics, 2013
In telepulmonology a general practitioner (GP) digitally consults a local pulmonologist. This stu... more In telepulmonology a general practitioner (GP) digitally consults a local pulmonologist. This study assessed the effect of telepulmonology on quality and efficiency of care. Efficiency of care was measured as the percentage of prevented physical referrals. Quality of care was measured using 5 indicators. Thirty-one percent of the TelePulmonology Consultations (TPCs) were sent to prevent a physical referral, the other TPCs were sent to ask for advice of the pulmonologist. Sixty-eight percent of the TPCs sent to prevent a physical referral indeed prevented a physical referral. Eighteen percent of the TPCs sent for advice resulted in a physical referral on advice of the pulmonologist. These patients would not have been referred without telepulmonology.
Respiratory Medicine, 2014
Background: Interpreting spirometry results has proven challenging in primary care practice, amon... more Background: Interpreting spirometry results has proven challenging in primary care practice, among others potentially leading to under-and misdiagnosis of COPD. In telepulmonology a general practitioner (GP) digitally consults a pulmonologist to support the interpretation of spirometry results. This study assessed the effect of telepulmonology on quality and efficiency of care. Methods: Quality of care was measured by five indicators, among others the percentage of Tel-ePulmonology Consultations (TPCs) sent by GPs for advice, percentage of those TPCs resulting in a physical referral, and educational effect of telepulmonology as experienced by GPs. Efficiency was defined as the percentage of prevented unnecessary physical referrals of patients to the pulmonologist. Results: Between April 2009 and November 2012 1.958 TPCs were sent by 158 GPs to 32 pulmonologists. Sixty-nine percent of the TPCs were sent for advice. Based on the advice of the pulmonologist 18% of these TPCs led to a physical referral of patients who would not have been referred without telepulmonology. Thirty-one percent of the TPCs were intended to prevent a physical referral, 68% of these actually prevented a physical referral to a pulmonologist.
European Respiratory Journal, 1998
The relationship between the abnormalities in the different routine lung function tests and the d... more The relationship between the abnormalities in the different routine lung function tests and the degree of functional limitation during exercise is not well established in upper airway obstruction (UAO). On the contrary, in chronic obstructive pulmonary disease (COPD), for instance, a forced expiratory volume in one second (FEV1) of 60% predicted is generally associated with a peak expiratory flow (PEF) of 60-70% pred and corresponds with a moderate physical impairment of ~20-30% [1, 2]. Yet, in UAO, FEV1 will still be 70-80% pred when PEF is only 40-50% pred and it is not established what the clinical relevance is of each of these changes in terms of exercise limitation, although it is generally accepted that FEV1 is an insensitive test for UAO .
CHEST Journal, 1991
can be found online on the World Wide Web at:
American Journal of Respiratory and Critical Care Medicine, 1995
A fixed orifice or a fixed upper airway obstruction (UAO) causes an expiratory and inspiratory pl... more A fixed orifice or a fixed upper airway obstruction (UAO) causes an expiratory and inspiratory plateau-shaped limitation on maximal flow-volume (MEFV, MIFV) curves and, according to the classic concept, a MEF50/MIF50 ratio of 0.9-1.1. However, since maximal expiratory static transrespiratory pressures (PEmax,stat) are clearly greater than the inspiratory ones (PImax,stat), the pressures applied during forced expiration also must be expected to be greater than inspiratory pressures; therefore, the MEF should be larger than the MIF because orifice flow is effort-dependent. We investigated this hypothesis in seven healthy, nonsmoking male volunteers (mean age +/- 1 SD: 34 +/- 10 yr, FVC: 5.9 +/- 1.0 L, PEmax,stat: 168 +/- 16 cm H2O, PImax,stat: 107 +/- 33 cm H2O). They performed MEFV curves and MIFV curves through four different added resistances placed in between the pneumotachograph and the mouth (the orifice diameters ranged between 7.8 mm and 2.8 mm). During these maneuvers dynamic mouth pressures were also measured (PE and PI). We found that the MEF50/MIF50 ratios were significantly increased (p < 0.05) from a control value of 1.1 +/- 0.4 up to 1.5 +/- 0.3 with the resistances. For each added resistance the PE/MEF ratios and (-)PI/MIF ratios were situated on a single line corresponding with the pressure-flow (P/V) characteristics of the resistance. We concluded that external resistances cause a MEF50/MIF50 ratio of clearly more than 1 and that this is determined by the PE/(-)PI ratio, which in healthy subjects is markedly larger than 1.
European Respiratory Journal, Sep 1, 2011
Chest Journal, Feb 1, 1993
prednisone. sarcoidosis. Favorable effect of propranolol and Bleeding varices due to portal hyper... more prednisone. sarcoidosis. Favorable effect of propranolol and Bleeding varices due to portal hypertension in http://chestjournal.chestpubs.org/content/103/2/628 can be found online on the World Wide Web at: The online version of this article, along with updated information and services ) ISSN:0012-3692 http://chestjournal.chestpubs.org/site/misc/reprints.xhtml A 58-year-old white man had bleeding varices in the gastric fundus due to portal hypertension attributable to histologically proven hepatic sarcoid involvement with a giant splenomegaly and with an angiographically demonstrated significant flow toward the liver. Treatment with corticosteroids and beta-blockade (30 mg propranolol daily) resulted in no rebleeding for over one year follow-up (Chest 1993; 103:628-29)
Nederlands tijdschrift voor geneeskunde, Jan 18, 1992
We report a 27-year-old man, who became comatose after autopoisoning with a high dose of valnocta... more We report a 27-year-old man, who became comatose after autopoisoning with a high dose of valnoctamide. He was mechanically ventilated for 12 hours and survived without serious side effects. Valnoctamide blood levels were monitored in order to study the pharmacokinetics of oral overdosing of this drug. Serum half-time levels appeared to be approximately 15 hours.
Acta oto-rhino-laryngologica Belgica, 1995
Few data are available on the relative sensitivity of different lung function tests in upper airw... more Few data are available on the relative sensitivity of different lung function tests in upper airway obstruction (UAO) and on the correlation of these tests with radiological estimations of tracheal stenosis. This paper is based on patients with a goiter or tracheal tumor and in healthy subjects breathing through rigid resistors, as well as on literature data. Lung function abnormalities present a specific pattern in UAO: this is characterised by a typical shape of the maximal flow-volume curve, a marked reduction in peakflow (PEF) and only minor changes in routine spirometry (e.g. FEV1, which thus tends to underestimate the stenosis). The clinical relevance of the lung function abnormalities in UAO can be estimated from their relationship with the exercise limitation: a moderate exercise limitation to about 60% pred is found if PEF is reduced to about 40% pred, and Raw is increased to about 600% pred (in which instance FEV1 is still 75% pred). This limitation grossly corresponds to ...
The Netherlands journal of medicine, 1992
We report a male Caucasian, with a Dengue virus infection imported from Thailand to The Netherlan... more We report a male Caucasian, with a Dengue virus infection imported from Thailand to The Netherlands. General characteristics of the disease are presented and the supposed pathogenetic mechanisms of the disease are discussed.
C52. BACTERIAL PNEUMONIA: TREATMENT, 2010
Netherlands Heart Journal, 2008
We describe a patient who developed generalised pruritis with oedema and rash two weeks after she... more We describe a patient who developed generalised pruritis with oedema and rash two weeks after she had started taking clopidogrel following coronary stent implantation. In the absence of other likely causative agents, clopidogrel hypersensitivity was probable. She was treated with a rapid oral desensitisation procedure, after which a daily dose of 75 mg clopidogrel was well tolerated. No major adverse events occurred during a follow-up period of eight months. Oral desensitisation in clopidogrel hypersensitivity seems to be a safe method to reduce the risk of coronary stent thrombosis. (Neth Heart J 2008;16:21-3).
Respiratory Medicine CME, 2010
Severe hypothyroidism is associated with a wide spectrum of pulmonary and cardiovascular disorder... more Severe hypothyroidism is associated with a wide spectrum of pulmonary and cardiovascular disorders. However, it rarely presents with pleural effusion. A 57-year-old woman presented with a stroke and leftsided pleural effusion was suspected of having hypertensive cardiomyopathy. During the treatment with diuretics, her renal function deteriorated and she developed a complete respiratory insufficiency, which led us to the definitive diagnosis. Therapy with thyroid hormone resulted in significant clinical improvement and the pleural effusion disappeared. Myxedema is easily missed when myxedema and pitting edema are simultaneously present in one subject. Severe hypothyroidism should be considered in the differential diagnosis of unexplained pleural effusion.
European Respiratory Journal, 1994
L Lu un ng g f fu un nc ct ti io on n, , C CT T--s sc ca an n a an nd d X X--r ra ay y i in n u u... more L Lu un ng g f fu un nc ct ti io on n, , C CT T--s sc ca an n a an nd d X X--r ra ay y i in n u up pp pe er r a ai ir rw wa ay y o ob bs st tr ru uc ct ti io on n d du ue e t to o t th hy yr ro oi id d g go oi it tr re e Lung function, CT-scan and X-ray in upper airway obstruction due to thyroid goitre. ABSTRACT: The purpose of this study was to assess the clinical reliability and to compare routine lung function tests (maximal flows and resistance) and radiological images (computed tomography (CT)-scan and X-ray) in upper airway obstruction. We, therefore, performed these examinations prospectively in 28 female patients (aged 68±13 yrs) with a goitre and without pulmonary disorders. Lung function measurements consisted of maximum expiratory and inspiratory flow-volume curves and of airway resistance. CT-scans and X-rays were performed during apnoea at functional residual capacity (FRC).