Research as postgraduate student
Options for research as postgraduate student uitklapper, klik om te openen
- Participation in an ongoing study, in a differentiation module in the 3rd year of training. You conduct a study of the literature or a subproject.
- PhD track General Practice as 'PhD Candidate General Practice ' You will have to be admitted to both the general practice training and a general practice research project. Both tracks are closely intertwined.
- PhD graduate track: PhD graduates can combine general practice research with general practice training as postgrads.
Basis principles for a General Practice PhD track:
- part of the research may be conducted prior to the first year of the program
- at least one year of research during the program
- no more than one consecutive year of research at a time during the program
- your training period and research can be extended to up to 6.5 years.
Direct placement
In principle, you follow general practice training at the same UMC as where you conduct research. If you already have a PhD position during the selection procedure for the general practice program, you can be directly placed in Utrecht. You must indicate this when you register for the selection procedure. An internal assessment will take place afterward. Go to the selection website for the conditions for direct placement.
Further information?
LOVAH, the Dutch association of postgraduate students, has a network for PhD Candidates General Practice.The LOVAH website contains a lot of information.
Interested? The coordinator for PhD Candidates General Practice, Marie-Louise Barteling, can give you more information. She can also keep you informed of job vacancies for PhD positions suitable for a PhD track General Practice.
Current GP postgraduate students and graduates uitklapper, klik om te openen
Anne Dekker
Rational Antibiotic Prescribing For Children With Respiratory Tract Infections
PhD Candidate General Practice Anne Dekker studied how the unnecessary prescription of antibiotics for respiratory tract infections can be reduced by means of a simple training. She earned her PhD in 2018. Antibiotics for children are mainly prescribed for respiratory tract infections and ear infections. This is not always in accordance with the guidelines. To date, there are relatively few interventions to reduce antibiotics use in children. The RAAK intervention was studied in 32 general practices. A combination of online training for general practitioners and information material for parents significantly reduced the number of antibiotics prescriptions in the study group. Interviews with parents showed that the material did not change the parents' opinion of antibiotics as much as helping them to accept a wait-and-see policy. While the training did not contain a lot of new information for the general practitioners, it did refresh their knowledge and made them more aware of their own prescription policy, as a result of which they were more inclined to change it. The recommendation is to introduce the RAAK intervention, which is relatively cheap, in other general practices as well.
Judith Poldervaart (Postgrad)
How can we make care on the interface between primary and secondary care more safe? (TIPP)
No letter of discharge, while, as a general practitioner, you are faced with a patient asking what will happen next after the diagnosis bowel cancer. Or a referral without any question, while, as a geriatrician, you have to assess a patient with Alzheimer's in A&E with no caregiver present. All general practitioners are confronted every day with patient transfers between primary and secondary care and with shared patient care. The objective of the Transmural Incidents Prevention Program (TIPP) is to develop, substantiate and evaluate a program to promote transmural safety in healthcare. This includes the development of a shared vision of transmural safety and improvement of communication about and shared learning from transmural incidents. TIPP also studies possible culture differences between the general practice and the hospital and takes these differences into account. This research project focuses particularly on the role of the patient, who is the only one who is involved in all care moments of the transmural process. We hope that the TIPP study will create greater awareness of transmural patient safety and the consequences this may have for physician and patient. We also want to inspire physicians and help them identify opportunities for improvement. Judith Poldervaart obtained her doctorate in February 2016.
Ilse Badenbroek
Effectiveness and cost-effectiveness of an integrated cardiometabolic prevention program: INTEGRATE
We are seeing an increase in the number of cardiometabolic disorders. Screening and effective treatment and prevention are required to maintain the patient's good quality of life and reduce the costs of care. In the INTEGRATE study, a randomized trial in 60 general practices, patients without cardiometabolic disorders will be screened for risk factors. At-risk patients will receive treatment or prophylaxis with a view to preventing cardiometabolic disorders. Differences between risk factors at baseline and after a year of follow-up will be used to determine effectiveness and cost-effectiveness. The study also evaluates which factors play a role in the willingness to participate and therapy compliance.
Carline van den Dries
Integrated care for patients with atrial fibrillation in general practice (ALL-IN)
The treatment of patients with atrial fibrillation (AF) involves various healthcare professionals, including the thrombosis clinic and the cardiologist. The general practitioner often plays a limited role in the treatment of AF, but does have the best overview of the patient's other disorders and medication. With a view to the increasing number of AF patients and the changes in anticoagulant care, it is important to study whether integrated AF care (supervision of anticoagulant treatment and treatment of comorbidity) can take place safely in general practice. That was why the ALL-IN study was set up, a pragmatic, cluster randomized study that was started in the Zwolle region in 2016. Patients in intervention practices are checked for atrial fibrillation four times a year, in connection with cardiac and non-cardiac comorbidity. The general practice also takes over the INR tests from the thrombosis clinic. After two years, we will look at mortality, hospital admissions, CVAs, hemorrhages and cost-effectiveness.
Anouk Eikendal (postgrad)
PReclinical dIastolic Dysfunction and its progression to heart failure with preserved ejection fraction in women and mEn (PRIDE)
Heart failure is an increasing issue in today's healthcare, both economically, medically and socially. Gender differences do seem to play a key role in heart failure. Where women more often suffer from heart failure with preserved ejection factor (HFpEF), men more frequently have heart failure with reduced ejection fraction (HFrEF). Unlike the treatment of HFrEF, there is no successful treatment for HFpEF yet. PRIDE focuses on the improvement of prevention and treatment of HFpEF by detecting it at an earlier stage, when it can be treated better. This is done by more efficiently mapping the gender-specific risk factors related to the development and progression of (the precursor stage of) HFpEF, as well as the gender-specific relationship between findings of ultrasound imaging, risk factors, and the mortality and morbidity of heart failure.
Nicole van Erp
DICKENS study: Diagnostic Intervals in the care process of Cancer in the Netherlands
The general consensus is that cancer must be detected as early as possible, because a delay results in an increase in both the psychological and the physical disease burden. For the Netherlands, it has not be ascertained yet how long the different stages of the diagnostic process last and what determines the variance in these completion times. The objective of this study is to map out the duration of the different stages of the diagnostic process for ten types of cancer in the Netherlands. In addition, we study the variation in these completion times for the different types of cancer and what predictors there are for relatively long or, conversely, short diagnostic intervals. This is intended to find leads for optimization of the diagnostic process and, as a result, a reduced disease burden for cancer patients.
Jolien Janssen
Cognitive problems in people with type 2 diabetes mellitus
This PhD research consists of two studies of the cognitive problems in people with type 2 diabetes mellitus. The COG-ID study focuses on the diagnostics of cognitive problems in general practice. The study investigates the diagnostic value of two questionnaires filled in by the patients themselves; these may serve as an alternative to MMSE. The other study, CAROLINA, is a large-scale international, double-blind, randomized study focusing on the prevention of cognitive problems in people with type 2 diabetes. In this study, the effect of treatment with the glucose-reducing medicine linagliptin (DDP-IV inhibitor) and the frequently used medication glimepiride are compared.
Linda Joosten
Switching anticoagulants (from VKA to NOAC) in frail elderly people with atrial fibrillation (FRAIL-AF)
Non-vitamin K antagonist oral anticoagulants (NOAC) are increasingly preferred over vitamin K antagonists (VKA) for treatment of patients with atrial fibrillation (AF) to reduce the risk of thrombosis. A large group of AF patients is frail and old to very old. Hardly any research has been done to date into the safety of NOACs' in this patient group. As a result, it is still unclear which anticoagulant should be prescribed to this growing patient group: a VKA or a NOAC?
The FRAIL-AF is a pragmatic, multicenter, randomized study started at the end of 2017. Patients are included through thrombosis clinics throughout the Netherlands. After a one-year follow-up, we look at the emergence of hemorrhages, thromboembolic disorders, CVAs', quality of life, cost-effectiveness and risk factors for hemorrhagic complications.
Femke Kaasenbrood
Improving DEtection of Atrial fibriLlation in primary care (IDEAL)
Unrecognized and therefore untreated atrial fibrillation (AF) is a common cause of invalidating CVAs. At the moment, AF is diagnosed mainly if the general practitioner suspects AF as a result of the complaints with which the patient presents. The diagnosis is made by means of an electrocardiogram (ECG) in the general practice or hospital.
AF mainly afflicts elderly people, but they often experience few complaints from AF. This study investigates whether an electronic device, the MyDiagnostick, can be used to detect AF. A patient with AF can be recognized by holding this device for one minute. The effect of the MyDiagnostick is studied in a randomized trial in general practices.
Carmen Erkelens
Learning how cognitive bias occurs during triage interviews
This PhD track is part of a dual process in the Safety First project. Both tracks look at triage interviews, specifically with callers with suspected cardiovascular complaints. Forms of cognitive bias occur during these interviews that may lead to incorrect grading of urgency in triage. When we understand better if and how bias in these interviews can be recognized, we can better train triage nurses in making the right decisions.
Saskia Hullegie
The treatment of children with acute otitis media who present with acute otorrhea (PLOTS)
Acute otitis media (AOM) is one of the most common infectious diseases in children. Approximately 15 to 20% of the children with AOM present with otorrhea as a result of a spontaneous perforation of the eardrum. The current NHG standard recommends oral antibiotics, as these have proven effectiveness in reducing ear ache and/or fever in children with AOM and otorrhea. However, this treatment may result in systemic adverse effects and an increase in resistance. The Painful Otorrhea Therapy Study (PLOTS) studies whether antibiotics-corticosteroid ear drops can be a good alternative to oral antibiotics in children with AOM with acute otorrhea.
Ietje Perfors
The effects of additional supervision by the general practitioner and nurse during the oncological process (GRIP)
The number of oncology patients and former oncology patients is set to increase over the coming years. Authorities, patient organizations, the Dutch College of General Practitioners and hospitals believe that general practitioners can play an ongoing role in the oncological process. The objective of the GRIP study is to evaluate the effects of ongoing involvement of primary care throughout the oncological process.
In a randomized multicenter trial, half of the cancer patients will be offered primary care support in addition to their usual care. The trial includes breast cancer, colorectal cancer, lung cancer, prostate cancer and melanoma patients.
Vivianne Sloeserwij
Optimization of pharmacotherapy through integration of non-dispensing pharmacist in general practice (POINT)
Medicines may improve health, but can also cause damage. Almost half of hospital admissions related to use of medicines can be avoided. Conducting medicine assessments in primary care may improve the safety of pharmacotherapy, but practical implementation proves difficult. The POINT study investigates the effect of a new approach in primary pharmacotherapeutic care in the Netherlands: integration of a non-dispensing pharmacist in the general practice. The primary focus is on the number of hospital admissions related to medication. Potential medication errors and costs are also studied.
Emmy Trinks-Roerdink
National registration of patients with atrial fibrillation (DUTCH-AF)
Atrial fibrillation is the most common arrhythmia disorder and a key risk factor for an ischemic CVA. Anticoagulants (vitamin K antagonists, or VKA, and non-vitamin K antagonist oral anticoagulants, or NOAC) reduce the risk of an ischemic CVA. There is no knowledge of how patients with atrial fibrillation are treated in daily practice. The objective of this prospective observational study is the national registration of patients with atrial fibrillation in both primary and secondary care. Aspects studied entails anticoagulant dosing and therapy compliance.
Rosanne Van Maanen
Diagnosing Pulmonary Embolism in the context of Common Alternative diagNoses in primary care (PECAN)
General practitioners use a decision rule and D-dimer test to diagnose pulmonary embolism. However, D-dimer is often falsely elevated, which results in unnecessary, expensive and potentially harmful CT scans. A new decision rule was recently developed: the YEARS strategy. As part of this strategy, a D-dimer test is performed on each patient and the physician scores three items: presence of hemoptoe, clinical signs of DVT, and whether pulmonary embolism is the most likely diagnosis. If none of these items are present, a higher D-dimer cut-off value of 1000mcg/L is used, while the 'classic' cut-off value of 500mcg/L is used in the presence of one or more of these items. In secondary care, this strategy resulted in 14% fewer CT scans with the same level of safety. The objective of the PECAN study is to validate this decision rule in primary care with the use of a point-of-care test for D-dimer. We also study the diagnostic added value of measuring CRP in these patients.
Suzanne Marchal
ZWOlle Transmural CArdiovascular risk management chain care with customized Substitution (ZWOT-CASE)
Since January 2016, the Zwolle region offers chain care for (cardio) vascular risk management ((C)VRM). The objective of (C)VRM chain care is to improve the quality of care and reduce cardiovascular morbidity and mortality. The ZWOT-CASE study investigates the effect of this chain care. In a clinical trial, patients from general practices that offer (C)VRM chain care are compared to patients from general practices that do not offer (C)VRM chain care (control group). In addition, the substitution of (C)VRM patients from secondary to primary care is mapped and followed up. Thirdly, a cohort study is conducted into the long-term effects of (C)VRM chain care. To this end, all patients who have started with (C)VRM chain care will be followed for three years. Aspects studied include a number of measurement values (blood pressure, cholesterol, BMI), lifestyle (smoking), the care process (number of consultations) and cardiovascular morbidity and mortality.
Loes Wouters
Optimalisatie initiële anamnese bij patiënten met verdenking acuut coronair syndroom, AAA en TIA/CVA (SAFETY FIRST)
Sinds 2011 werkt het merendeel van de huisartsenposten in Nederland volgens de Nederlands Triage Standaard (NTS), net als de Meldkamer Ambulance en SEH-verpleegkundigen. Het doel van de NTS is de veiligheid en doelmatigheid van de triage in de acute zorg te verhogen, zodat de patiënt zo snel mogelijk bij de juiste hulpverlener komt en de juiste behandeling of zorg krijgt. In het promotieonderzoek SAFETY FIRST wordt de telefonische initiële anamnese geëvalueerd bij patiënten met ingangsklachten passend bij acuut coronair syndroom, AAA en TIA/CVA en de uiteindelijke diagnose opgespoord middels follow-up bij de huisarts. Doel is het ontwikkelen van een nieuw diagnostisch model om deze acute cardiovasculaire ziekten beter vast te stellen in de huisartsgeneeskunde. Ook worden calamiteiten/incidenten beoordeeld die betrekking hebben op een ACS, AAA en TIA/CVA en wordt beoordeeld in hoeverre afleiders (‘cognitive’ bias) een rol spelen. Dit project integreert drie onderzoeksdomeinen: diagnostisch onderzoek van hart- en vaatziekten, patiëntveiligheid en onderwijs.
Rick van Uum
PIM-POM: a study of the best treatment for otitis media
In the PIM-POM study, we investigate the effect of a multiple intervention aimed at optimal pain control in children with acute otitis media (AOM) in general practice compared to usual care. It is a pragmatic cluster randomized intervention study in which general practitioners in the intervention group receive an online education module.
Lisanne Welink
Together for Evident Evidence
The objective of the research program ‘Together for Evident Evidence’ is to map how general practice trainers and postgraduate students deal with the three pillars of evidence-based medicine (EBM) in general practice and how they learn and could learn from each other in this area.
This study is part of the Education research program of the Utrecht General Practice Training Institute.