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Nederlands Tijdschrift Voor Geneeskunde

R J R Bouwmans, P B M Robben, R D Friele
The Netherlands Health and Youth Care Inspectorate (IGJ) wants to take the patient's perspective into account more often in its supervision of quality of care. The inspectorate already has some insight into this perspective via patients' reports; patients report complaints with the aim of preventing recurrence of the problem. However, the inspectorate does not further investigate the vast majority of these complaints and, furthermore, complaints with a clinical aspect are investigated far more often than organisational or communicational problems...
2018: Nederlands Tijdschrift Voor Geneeskunde
M G Sweegers, L M Buffart
OBJECTIVE: To investigate whether the effects of exercise on quality of life and physical functioning in patients with cancer is dependent upon certain patient characteristics or on specific training programmes. DESIGN: Meta-analysis of individual patient data (IPD) and a standard meta-analysis of randomized interventional studies. METHOD: Results from various randomized interventional studies were pooled for the analysis. Differences in effects of exercise among patients with different demographic and clinical characteristics were investigated using interaction terms applied to IPD...
2018: Nederlands Tijdschrift Voor Geneeskunde
J R Vos, W A G van Zelst-Stams, N Hoogerbrugge
Approximately one million patients in the Netherlands and 27-36 million patients in Europe have one of the 5,000-8,000 known rare diseases. These patients often do not receive the care they need or with a substantial delay from diagnosis to treatment. As of March 2017, 24 European Reference Networks (ERNs) were launched with the aim to improve the care for these patients through cross-border healthcare, where in principle the knowledge travels and not the patient. It is expected that through the ERNs, European patients with a rare disease get more often and more quickly access to expert care and that it will accelerate guideline development and research...
2018: Nederlands Tijdschrift Voor Geneeskunde
M P Steenbeek, J Bulten, N Hoogerbrugge, L F A G Massuger, J M A Pijnenborg, J A de Hullu
BACKGROUND: Recent insights in high-grade serous ovarian cancer development are pointing to the fallopian tubes as likely place of origin and not the ovaries themselves. This may have consequences for patients with increased risk of ovarian cancer. Adnexal removal is currently recommended for this patient group at an age of 35-45, which leads to premature menopause. CASE DESCRIPTION: In a 55-year-old woman with a BRCA1 germ line mutation, a high-grade serous carcinoma was unexpectedly diagnosed in both fallopian tubes during preventive adnexal removal...
2018: Nederlands Tijdschrift Voor Geneeskunde
M Figee, P R Schuurman, D Denys
- Deep brain stimulation (DBS) corrects pathological activity of neuropsychiatric brain networks with high frequency current via implanted brain electrodes.- DBS is an effective and safe treatment for therapy-refractory obsessive-compulsive disorder and potentially also for therapy-refractory major depressive disorder.- Experimental psychiatric indications for DBS are Tourette syndrome, addiction, anorexia nervosa, post-traumatic stress disorder, autism and schizophrenia.- DBS influences brain networks that are relevant for a variety of psychiatric symptoms...
2018: Nederlands Tijdschrift Voor Geneeskunde
E C T Geijteman, M Oolbekkink, H J van Esch
In the Netherlands, patients who have a life expectancy of less than three months may be admitted to a hospice. In a small number of patients, however, their life expectancy is underestimated. It is assumed that patients are delighted to have this extra time. We present the cases of three patients admitted to a large Dutch hospice: two females aged 82 and 83 years, and a 49-year-old man -who ended up living (significantly) longer than expected. Their cases make clear that patients in this situation may suffer from psychological, psychosocial, and existential distress...
2018: Nederlands Tijdschrift Voor Geneeskunde
A F Engelsman, E J M Nieveen van Dijkum
The use of intraoperative neuromonitoring (IONM) in thyroid surgery has steadily increased in recent years. This technique helps to identify different nerves in and around the operation site, such as the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve. Particularly in patients who undergo a second operation or a complex procedure for malignancy, the technique's value has been demonstrated. However, in non-complex thyroid operations the risk of vocal cord paresis due to iatrogenic injury of the RLN is 0...
2018: Nederlands Tijdschrift Voor Geneeskunde
M H J Schepens, C M P Ziedses des Plantes, D M Somford, J A van Erkelens, R G Cremers, S de Vries, K K H Aben, R Hoekstra, J J C Stienen, B P Wijsman, M B Busstra, J van Limbeek
OBJECTIVE: To determine the effect of radical prostatectomy (RP) hospital volume on the probability of post-RP incontinence. DESIGN: Retrospective research based on claims-based data of health insurers. METHOD: For every patient with RP the probability of incontinence was determined, based on the definition of claims of one or more incontinence pads per day. Casemix corrections were made based on indicators available in claims-data: age, lymph node dissection, and radiotherapy...
2018: Nederlands Tijdschrift Voor Geneeskunde
E P Baerends, W W E Nolet
Consult Online is a Dutch telemedicine system for physicians who work in international healthcare and tropical medicine (formerly known as 'tropical doctors'). It provides specialist advice for complicated cases where local specialist services are lacking. Eighty-nine experts from 25 different specialties are available for advice via Most of these experts have worked in low resource settings for years before becoming specialists in other disciplines. Since its inception in 2008, Consult Online has received 639 consultations from 41 different countries...
2018: Nederlands Tijdschrift Voor Geneeskunde
L Zijp, P M J H Kemperman, G W den Tusscher
BACKGROUND: Urticaria multiforme is a rare clinical variant of urticaria that occurs specifically in children. CASE DESCRIPTION: A boy aged 11 months was presented at the Emergency Department with acute onset of itching urticarial skin weals and acral oedema. This picture is consistent with the diagnosis of urticaria multiforme. CONCLUSION: The diagnosis of urticaria multiforme can be made on the basis of the clinical picture. Treatment is symptomatic and in most cases this condition resolves spontaneously within two weeks...
2018: Nederlands Tijdschrift Voor Geneeskunde
J H Volders, N M H Krekel, M H Haloua, S Meijer, M P van den Tol
Recent literature shows that perioperative ultrasound guidance of surgery for palpable and nonpalpable breast carcinoma results in improved surgical effectiveness. Ultrasound-guided surgery can easily lead to significant improvement of the number of radical resections and can decrease the need for additional surgery or extra radiotherapy. Ultrasound-guided surgery also contributes to a reduction in the amount of excessive breast tissue removal, which means the final cosmetic result is better. Ultrasound-guided surgery is cost-effective and easy to learn...
2018: Nederlands Tijdschrift Voor Geneeskunde
A J M Oosterwijk, J W van den Berg, C C van Rossem
A 49-year-old man came to the emergency room with abdominal pain, vomiting, diarrhoea and rectal bleeding. Both colonoscopy and CT of the abdomen showed cecocolic intussusception caused by an appendiceal mucocele. An ileocecal resection was performed via a laparoscopic approach and microscopy of the tissue showed a low-grade mucinous neoplasm.
2018: Nederlands Tijdschrift Voor Geneeskunde
G J Boersen, E C T Geijteman, D H Schweitzer
An 85-year-old man came to the emergency room because of vomiting a black fluid and melaena. He was hypotensive and had severe anaemia. We suspected an upper digestive tract bleeding and a gastroscopy was performed, which showed necrosis of the entire oesophagus. Within 24 hours of admission the patient died of hypovolemic shock.
2018: Nederlands Tijdschrift Voor Geneeskunde
C M Legemate, M J Hop, M K Nieuwenhuis, E Middelkoop, M E van Baar, C H van der Vlies
Early accurate assessment of burn depth is important to determine the optimal treatment of burns (conservative versus surgery). Laser Doppler imaging (LDI) is a technique that allows accurate measurement of burn depth by measuring dermal perfusion. Although it has been demonstrated that LDI led to faster decisions as to whether or not to operate, this has not lead to shorter wound healing time or cost savings in Dutch burn care. LDI is used in all Dutch burn centres. In case of doubt about the depth of a burn in primary or secondary care, referral to a burn centre is advisable...
2018: Nederlands Tijdschrift Voor Geneeskunde
R H C Zegers
Most physicians receive gifts from their patients during their careers, but what to think of these presents and how to react to them? For many years, generous patients led to uneasiness: they might expect special services from the physician; or other patients - who did not give anything - could feel disadvantaged over generous patients. These are good reasons not to be too keen on gifts. They still lead to uneasiness now, but the situation has nevertheless been reappraised as it goes against the general tendency to complain about everything: a token of appreciation is welcome...
2018: Nederlands Tijdschrift Voor Geneeskunde
R B van Leeuwen, E van Wensen, B R Schudel
Identifying the occurrence of stroke in patients with isolated vertigo is difficult for general practitioners (GPs) as well as for physicians working in the Emergency Department. Three patients with acute vestibular syndrome are presented in this clinical lesson. The importance of an adequate neuro-otological examination is emphasised. However, many GPs lack knowledge of the nystagmus and the head impulse test. Alternative strategies for GPs are discussed.
2018: Nederlands Tijdschrift Voor Geneeskunde
P J Jongen
Doctors and patients are increasingly choosing treatment options by means of the shared decision-making process. However, human decisions are subject to cognitive bias, i.e. systematic and predictable errors in probability estimation and information synthesis. Decision-making may also be hampered by incomplete information. Clinical Drug Profiles (CDPs) aim to provide up-to-date, evidence-based and independent information about drug characteristics that are relevant to doctors and patients alike in the context of shared decision-making...
2018: Nederlands Tijdschrift Voor Geneeskunde
T M S van Winden, M M C Bruijn, M A Oudijk, G J van Baaren, A H L C van Kaam, B W J Mol, M Kok
OBJECTIVE: Analysis of national implementation of the foetal fibronectin test in the diagnostics of threatened preterm labour in the Netherlands, and indication of the possible obstacles and consequences of implementation or no implementation. DESIGN: National questionnaire, retrospective cohort study and cost-effectiveness calculation. METHODS: We approached all hospitals in the Netherlands (n = 86) with a questionnaire on use of the fibronectin test...
2018: Nederlands Tijdschrift Voor Geneeskunde
T Lorjé, M E C Waaijer, L E A M M Spierings
We describe a 53-year-old man presenting at the emergency department with sepsis and a swollen right hand. Over the course of a day a large haemorrhagic bulla developed on the back of the hand. The blood cultures were positive for Streptococcus pyogenes. Our diagnosis was bullous cellulitis leading to S. pyogenes sepsis.
2018: Nederlands Tijdschrift Voor Geneeskunde
F Ambagtsheer, L J van Balen, W L J M Duijst-Heesters, E K Massey, W Weimar
Patients travel worldwide to undergo kidney transplantations. Care providers in the Netherlands encounter these patients, both before and after the transplantation. We present the results of a survey that was distributed among Dutch transplant professionals about their experiences with patients who have undergone a kidney transplantation abroad. We propose that care providers should report illegal transplantations. Of the 241 surveyed professionals, 100 treated patients who travelled to a country outside the European Union for a kidney transplant...
2018: Nederlands Tijdschrift Voor Geneeskunde
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