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Nederlands Tijdschrift Voor Geneeskunde

R H H Groenwold, P M M Bossuyt
The study design for randomised double-blind studies is powerful. Randomisation and blinding ensure that the groups that are compared are truly exchangeable. Any differences in health outcomes can be attributed rightfully to the one aspect on which the study groups differ: the treatment. In this commentary, we argue that the use of this powerful study design at the wrong moment can lead to undesirable situations.
2017: Nederlands Tijdschrift Voor Geneeskunde
B J J van Tienoven, L Becude, W Thijs
A 42-year-old woman without a medical history presented herself to the emergency room with sudden onset of dyspnoea and progressive tachypnoea. The X-ray showed a bilateral pneumothorax. Additional anamnesis suggested this was caused by thoracic acupuncture she had received that afternoon because of her chronic low back pain.
2017: Nederlands Tijdschrift Voor Geneeskunde
J P Mackenbach, R A M Damhuis, J V Been
- In this article we give a short overview of new insights into the effects of smoking on health, both on smokers themselves and on those who are exposed to other people's tobacco smoke.- The number of diseases and conditions that are known to be caused by active smoking has now risen to over thirty.- The risk of premature death is not, as previously thought, twice as high in smokers as in non-smokers, but actually three times as high.- Passive smoking too has been shown to have a whole range of negative effects on health...
2017: Nederlands Tijdschrift Voor Geneeskunde
L Gil, M J T van de Ven, C Richter
The incidence of tuberculosis (TB) in the Netherlands is declining every year. We fear there may be a loss of knowledge and awareness of detecting TB in the new generation of medical specialists. As medical specialists a great challenge lies before us in maintaining the quality of TB control in the Netherlands. Collaboration between pulmonologist, infectious disease specialist, microbiologist and the public health services is a necessity. Here we describe how, in the region of Arnhem, we work closely with these medical specialists based on structural multidisciplinary meetings...
2017: Nederlands Tijdschrift Voor Geneeskunde
J A Overbeek, A W A van der Heijden, R M C Herings, G Nijpels
OBJECTIVE: To study the trend in the prevalence of diabetes in the Netherlands during the period 1999-2014. DESIGN: Descriptive study of prevalence. METHODS: The prevalence of diabetes during the period 1999-2014 was calculated on the basis of data from the PHARMO Database Network, a network of electronic databases that includes data from public pharmacies for 3.8 million residents of the Netherlands. A person with diabetes was defined as someone with at least two dispensings for a glucose lowering-drug within six months...
2017: Nederlands Tijdschrift Voor Geneeskunde
R H Westerdijk, B H R Wolffenbuttel, I P Kema, R S M E Wouters
BACKGROUND: With nephrotic syndrome, cortisol levels may be falsely lowered by loss of cortisol-binding globulin (CBG) in the urine. An incorrect diagnosis of adrenal insufficiency could therefore be made. CASE DESCRIPTION: We describe the case of a 52-year-old female with nephrotic syndrome that did not sufficiently respond to medication. Treatment management was complicated by symptomatic hypotension, which was thought to be caused by adrenal insufficiency. The cortisol levels in the blood were low and a clinical cause could not be identified...
2017: Nederlands Tijdschrift Voor Geneeskunde
A A Uijen, H J Schers
Continuity of care is one of the most important features of primary care. In this commentary we discuss the article by Maarsingh et al. regarding the relation between personal continuity (seeing the same care provider) and mortality. We raise some important points on the way continuity of care is measured and show how it affects the results. Our conclusion is that the relation between continuity of care and mortality is still weak. However, this does not alter the importance of having a personal care provider...
2017: Nederlands Tijdschrift Voor Geneeskunde
J C Karper, W M T Janssen, J C Breek, R Oosterhof-Berktas, J Gravendeel, T K Kremer Hovinga
BACKGROUND: A spontaneous renal artery dissection is a very rare diagnosis. The clinical presentation can vary and its course can be atypical. There are no guidelines available regarding treatment; however, the options are a conservative (medication) or interventional (radiological or surgical) approach. CASE DESCRIPTION: A 45-year-old man presented to the emergency department with hypertensive urgency after earlier episodes of flank pain. The cause appeared to be a spontaneous bilateral renal artery dissection with infarction...
2017: Nederlands Tijdschrift Voor Geneeskunde
J F Hamming
Structured assessments form a mandatory part of Dutch Medical Specialist Training, but create administrative workload for both the staff and supervisors. One could argue that the quality of the narrative feedback is more important than the extensive reporting in learning portfolios, and that the focus should be on continuous on-the-job coaching.
2017: Nederlands Tijdschrift Voor Geneeskunde
P van Baal, M Gheorghe
OBJECTIVE: Quantifying trends in quality-adjusted life expectancy (QALE) by level of education in the Netherlands 2001-2011. DESIGN: Retrospective study. METHOD: For this study we used data from several sources. Using regression models we estimated mortality rates and quality of life as functions of age, gender, calendar year and educational level. Quality of life was measured using the SF-6D questionnaire. In order to calculate QALE we combined estimates of mortality rates and quality of life into Sullivan's life tables...
2017: Nederlands Tijdschrift Voor Geneeskunde
E M Postma, Y C de Vries, S Boesveldt
- This article provides an overview of smell and taste changes in cancer patients and the influence of these changes on eating behaviour and food preferences.- Taste changes seem to be more common than alterations in the sense of smell.- The changes in taste and smell are often temporary; smell and taste functions mostly return to their previous level after treatment cessation.- The type of cancer and its treatment influence changes in the sense of smell and taste, making it challenging to give general advice...
2017: Nederlands Tijdschrift Voor Geneeskunde
R L T N Salden, S Postma
BACKGROUND: 'Excessive dynamic airway collapse' (EDAC) is a form of tracheamalacia, that does not affect the rings of cartilage on the anterior side of the trachea, but in which the posterior wall of the trachea collapses during inspiration and expiration. CASE DESCRIPTION: An 80 year-old woman presented to the accident and emergency department with dyspnoea and severe inspiratory and expiratory stridor, with sudden onset a few hours previously. Following a series of investigations, she was shown to have a narrowing of the trachea, radiating from the posterior wall...
2017: Nederlands Tijdschrift Voor Geneeskunde
K E Mager, J G M Frenken, M Guijt
A 15-year-old boy sustained a left tuberositas tibiae avulsion fracture as a result of jumping. This type of fracture typically occurs in adolescent boys during sports.
2017: Nederlands Tijdschrift Voor Geneeskunde
A V van Capelle, J de Valk, D Schakenraad, T Germans, D Ten Oever
BACKGROUND: Capecitabine is an orally-administered chemotherapeutic agent used in the treatment of colorectal, gastric and breast carcinoma. Capecitabine has relatively mild side effects. Less known are its potential severe cardiotoxic effects. CASE DESCRIPTION: We report a case of a 61-year-old man recently diagnosed with rectal cancer. Six days after starting with capecitabine, he developed a cardiac arrest due to ventricular fibrillation (VF). Extensive additional diagnostics did not explain the cardiac arrest nor VF...
2017: Nederlands Tijdschrift Voor Geneeskunde
S N van Vendeloo, P L P Brand, B J Burger, R G H H Nelissen, S K Bulstra, C C P M Verheyen
OBJECTIVE: To evaluate of the number of registered competency assessments in the portfolios of orthopaedic residents in the Netherlands, for whom a competency-based training programme is mandatory. DESIGN: National cohort study. METHOD: We collected data regarding the registered assessments of all orthopaedic residents who finished their training between 2012-2015. We determined the number of registered assessments of 'standard orthopaedic treatments' (evaluating residents' competency in 70 different orthopaedic treatments), objective structured clinical skills evaluations (OSCEs), critically appraised topics (CATs), and 360 degree feedback appraisals...
2017: Nederlands Tijdschrift Voor Geneeskunde
G L Vlaspolder, A F P M Vloemans, R S Breederveld
The initial care of a patient with burns is a challenge for every doctor. After cooling the burn appropriately, a careful history and a good initial assessment are of essential importance for treatment. The burn should be inspected regularly for early detection of any infection and to evaluate wound healing. If healing has not occurred in two weeks, hypertrophic scarring may develop and surgical treatment should be considered. It is always possible to contact the burns centres in Beverwijk, Rotterdam and Groningen to discuss treatment of the burn, any infection of a wound, consideration of surgical treatment, or transfer of a patient to a burn centre...
2017: Nederlands Tijdschrift Voor Geneeskunde
J G van der Hoeven
- Power is a charged issue but, when executed with integrity, a potent instrument to improve quality of care.- Execution of power has various manifestations, which have an important effect on several aspects of the care process including the doctor-patient relationship, primary responsible physician and the relationship with other team members.- Abuse of power is a source of conflicts and may also result in emotional exhaustion and burnout.- Various measures may stimulate the appropriate use of power.
2016: Nederlands Tijdschrift Voor Geneeskunde
T Magnée, D P de Beurs, D H de Bakker, P F M Verhaak
OBJECTIVE: The objective of this study was to examine mental health care provided by general practitioners and by mental health nurses working in general practices. DESIGN: Observational research. METHOD: We analysed how many consultations with patients with mental health problems were recorded in Dutch general practices in the period 2010-2014. General practices with and without a mental health nurse were compared, and we investigated which patients were mainly treated by mental health nurses...
2016: Nederlands Tijdschrift Voor Geneeskunde
R R Ossendorp, R Mollema, M C Richir
A 68-year-old female presented with acute abdominal discomfort in the left lower quadrant and a painful left leg. Her medical history only revealed an eating disorder. Physical examination was insignificant. Diagnostic imaging showed an obturator hernia; subsequently, a laparotomy was performed. An obturator hernia, also known as little old ladies' disease, is associated with abdominal pain and a painful leg.
2016: Nederlands Tijdschrift Voor Geneeskunde
F Hoexum, K Yeung, W Wisselink
A 28-year-old male was referred to our emergency department with a swollen left arm after intensive exercise. Physical examination revealed distension of the superficial veins of his left arm and chest. Duplex ultrasound confirmed the diagnosis of Paget-Schroetter syndrome. He was successfully treated with thrombolysis and first rib resection.
2016: Nederlands Tijdschrift Voor Geneeskunde
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