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Nederlands Tijdschrift Voor Geneeskunde

H J Schers, W J J Assendelft
In the Telephone First approach that has been introduced in the UK, within a few hours of patients contacting their GP practice a general practitioner will call back all patients who want to make an appointment within a few hours. We think that it is not wise to introduce this system in the Netherlands. Research has not shown sufficient advantages and the system hampers rethinking the traditional way of handling patient requests and the growing workload in general practice. Instead, focus should be paid to more diverse and innovative ways of dealing with patient demands...
2018: Nederlands Tijdschrift Voor Geneeskunde
T Nijsten, D J Hijnen
Dupilumab is the first and long-awaited biological for treatment of moderate to severe atopic dermatitis. In randomised clinical trials approximately 40% of patients using dupilumab 300 mg every two weeks were clear or almost clear of their eczema after 16 and 52 weeks. We now face the challenge of patient stratification to limit the budget impact of dupilumab and hope that more targeted therapies for atopic dermatitis will follow soon.
2018: Nederlands Tijdschrift Voor Geneeskunde
J J Luykx, J K Tijdink, W Tempelaar, C H Vinkers, L de Witte
A range of clinical syndromes may present with psychiatric symptoms, both in and out of hospital settings. In such situations agitation, suicidality, communication difficulties and legal aspects often play a role, making diagnosis and treatment a challenge. Based on several case studies, we illustrate how the recently-published Dutch open access source 'Acute Psychiatry' ( can be of help in acute psychiatric presentations both within and outside psychiatric hospitals.
2018: Nederlands Tijdschrift Voor Geneeskunde
B Botter, E Koolen, G van Montfort, F Bracke, A Bouwman, M Buise
BACKGROUND: Obesity is a chronic disease and a risk factor for heart failure. In end-stage heart failure, heart transplantation may be the only available treatment option, but obesity is a contraindication for this treatment because of its unfavourable prognosis. Bariatric surgery and its subsequent weight loss may affect the indication for transplantation in patients with heart failure and morbid obesity. CASE DESCRIPTION: A 46-year-old patient with morbid obesity and heart failure underwent gastric sleeve resection in preparation of a heart transplantation...
2018: Nederlands Tijdschrift Voor Geneeskunde
J A H R Claassen
- Orthostatic hypotension is a condition in which there is insufficient recovery of the blood pressure drop which occurs after getting up, which causes a temporary reduction of cerebral perfusion. This increases the risk of falls resulting in injuries.- Orthostatic hypotension is most common in the elderly. The cause is usually multifactorial (including reduced circulating volume, reduced peripheral resistance and limited heart rate increase). Orthostatic hypotension caused by autonomic dysfunction is called neurogenic orthostatic hypotension...
2018: Nederlands Tijdschrift Voor Geneeskunde
W Al-Arashi, E C T Geijteman, D H Schweitzer
A 47-years-old man presented with the complaint that he could not open his eyes in the morning. Facial myxedema caused by hypothyroidism was evident. Pictures taken after treatment for six months with levothyroxine showed complete recovery. Myxedema is caused by accumulation of glycosaminoglycans in the dermis.
2018: Nederlands Tijdschrift Voor Geneeskunde
I M Wichers, W Opstelten
Dr Robert Edgar Hope-Simpson (1908-2003) was a British general practitioner, who has laid the foundation for unravelling the pathogenesis of shingles. At the beginning of the 20th century, both conditions were known to be related, but the precise relationship was unclear. It was assumed that chickenpox could originate after infection by both a person with shingles or someone with chickenpox, but that both diseases were caused by different viruses. Through rigorous observations in his GP practice and during his field work on the island of Yell, Hope-Simpson developed his hypothesis about the - now scientifically accepted - pathogenesis of shingles...
2018: Nederlands Tijdschrift Voor Geneeskunde
G Morroy, D Ooms, H J Jansen, J Dijkstra, K J van Drunen-Kamp, J Batstra-Blokpoel
BACKGROUND: When two or more people fall ill after eating the same food, this is called an outbreak of food poisoning or food-related infection. In the Netherlands, physicians have to notify the Municipal Health Services (GGD) of such outbreaks. The GGD informs the Netherlands Food and Consumer Product Safety Authority (NVWA). CASE DESCRIPTION: Two clusters of scombroid poisoning (histamine poisoning in this case after eating tuna) occurred in one month. Due to the quick reporting of patients by physicians, the GGD and the NVWA immediately tracked down the source...
2018: Nederlands Tijdschrift Voor Geneeskunde
T W Elffers, J W Jukema
Coronary atherosclerosis is a common disease. The plaques developing inside coronary vessels may have serious consequences such as myocardial infarction. However, the course of this multifactorial and heterogeneous disease is difficult to predict and is different for each patient. Atherosclerosis is often described as a gradually progressive disease, but in addition to slow progression, a certain periodicity is often seen. There may be periods with more stability and periods of regression. Several processes are known to be involved in plaque development and their increasing vulnerability...
2018: Nederlands Tijdschrift Voor Geneeskunde
A J Poot
A thorough systematic literature review comparing care for the elderly provided by physicians and nurses with that provided by physicians alone finds a modest advantage for the first. The conclusion is that 'Physician substitution in healthcare for the aging population may achieve at least as good patient outcomes and process of care outcomes compared with care provided by physicians'. On closer inspection, the selected studies compare multidisciplinary care programmes including nursing staff with monodisciplinary physician care...
2018: Nederlands Tijdschrift Voor Geneeskunde
M Geerdes, S P Smook, T A von Schükkmann
A 42-year-old woman presented with neck pain without previous trauma. On suspicion of spondylodiscitis, an MRI of the cervical spine was made. This MRI and an additional CT showed calcific tendinitis of the longus colli muscle, a self-limiting disorder.
2018: Nederlands Tijdschrift Voor Geneeskunde
B J H Verhaar, M W Vernooij, G J Biessels, M Muller
- Cerebral microbleeds are associated with a higher risk of intracerebral hemorrhage.- When microbleeds are detected, the possible underlying pathology should be considered; this includes cerebral amyloid angiopathy and other factors that increase the risk of haemorrhage, particularly hypertension. - No randomised trials have yet been conducted into haemorrhagic complications and cerebral infarctions in patients with microbleeds who take vitamin K antagonists. This means that it is not clear whether the intended prevention of cerebral infarctions outweighs the increased risk of haemorrhage associated with use of vitamin K antagonists by these patients...
2018: Nederlands Tijdschrift Voor Geneeskunde
J Fleisch, A Dahan
- Cancer patients often experience pain that has a significantly negative effect on their daily living.- This pain may be caused by the disease process itself, but may also be related to the treatment such as chemotherapy-induced neuropathic pain, chronic pain following surgery and post-amputation pain.- In this training article we will discuss the different aspects of cancer-related pain, based on various questions posed by general practitioners and internists.- Items that are discussed include measurement of pain, opioid therapy, opioid side effects, adjuvant medication, barriers that preclude proper treatment of pain, opioid tolerance and addiction, and interventional therapy...
2018: Nederlands Tijdschrift Voor Geneeskunde
D Kiers, M Meermans, E Verstraete, H J van Leeuwen
BACKGROUND: Patients with decreased exercise tolerance and orthopnoea are often referred to an internist, a cardiologist or a pulmonologist. These symptoms can also be caused by weakness of the respiratory muscles, as an indication of a neuromuscular disease. If these symptoms are not recognized as such, this may result in a delay in timely diagnosis. CASE DESCRIPTION: An 82-year-old man had suffered from decreased exercise tolerance for 18 months. For the last months he had been sleeping upright and had lost 20 kg in weight...
2018: Nederlands Tijdschrift Voor Geneeskunde
O M Dekkers, R H H Groenwold
- An often provided interpretation of a significant p-value (p < 0.05) is that 'the probability the conclusion is incorrect, is only 5%'. This interpretation is incorrect.- It can be shown that for observational studies, in case of p < 0.05, the probability of a false positive signal is around 50%. This means that significant p-values give us much less certainty about the reliability of a conclusion than we like to believe.- Much would be gained already if the emphasis on p-values would be replaced by: (a) an estimation of the effect size in combination with the corresponding statistical uncertainty (represented by the confidence interval), (b) an assessment of the clinical relevance of that effect, and...
2018: Nederlands Tijdschrift Voor Geneeskunde
Y M Smulders, J G van den Aardweg
Nasal cannulae for oxygen administration are applied abundantly in clinical medicine, even though their use may cause patient discomfort. Although nasal cannulae may be effective in increasing oxygen uptake to some degree, they are unlikely to prevent severe hypoxaemia. Furthermore, they are often used when arterial oxygen saturation is already ≥ 90%, in which case additional oxygenation is usually not required, nor does it relieve the sensation of dyspnoea.
2018: Nederlands Tijdschrift Voor Geneeskunde
J N Pouw, K Klooster, D J Slebos, H van der Zeijden
BACKGROUND: Bullous lung emphysema is a progressive disease, which may be partly explained by gradual expansion of bullae. These air-spaces arise after destruction of alveolar lung tissue. In some patients, bullae can merge into a giant bulla comprising more than 30% of the hemithorax. This bulla compresses surrounding relatively healthy lung parenchyma and regression results in improvement of pulmonary function, exertional tolerance and quality of life. This can be achieved with medication, surgery and with new experimental bronchoscopic lung volume reduction therapy...
2018: Nederlands Tijdschrift Voor Geneeskunde
A Coenders, M Verregghen, E P Baerends
A 25-year-old Papuan presented with three painless foot ulcers with undermined edges, induration and oedema. The appearance was typical for Buruli ulcer, which is caused by Mycobacterium ulcerans. A smear was positive for acid fast bacilli. Buruli ulcers are found in patients from humid and tropical regions and are treated with rifampicin and streptomycin during eight weeks.
2018: Nederlands Tijdschrift Voor Geneeskunde
E J Lier, K Nielsen, M J P M Govaert
A 35-year-old woman with a history of gastric bypass presented with acute abdominal pain, nausea and an urge to move. She showed normal vital signs. We found abdominal guarding and elevated ASAT, ALAT and LDH. A CT scan showed the whirl sign, caused by a mesenteric herniation through the Roux-en-Y gastric bypass.
2018: Nederlands Tijdschrift Voor Geneeskunde
J L Groen, E M Bos, J W Berkelbach van der Sprenkel
There is a lot of research into the effectiveness of interventions, but good evidence for many interventions is missing. This is very true of simple and frequently performed treatments. These interventions are often done by trainees in the course of their specialist training, and for this reason they are in a unique position to carry out research into them. There are far fewer high-quality, multicentre clinical trials in the surgical specialisations than in any other specialisation. As trainee neurosurgeons, we are of the opinion that this can be improved upon...
2018: Nederlands Tijdschrift Voor Geneeskunde
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