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Nederlands Tijdschrift Voor Geneeskunde

P M J C Kuijpers
The strong association between distress and heart disease is frequently in the news, for example when a celebrity dies after terrible news such as death of a child. Researchers in the Netherlands found that high scores on the Cardiac Anxiety Questionnaire after a myocardial infarction lead to an increased risk of new cardiac events, regardless of underlying cardiac disease severity. Although the brain-heart axis is well known in literature, it is hardly a common subject in daily clinical cardiac practice. Signs and symptoms frequently lead to an 'oculostenotic reflex' instead of proper mental diagnosis...
2017: Nederlands Tijdschrift Voor Geneeskunde
A C Deden, P Hissink Muller, N M Appelman-Dijkstra, H M Kroon, G A Tramper-Stranders
BACKGROUND: Osteomyelitis is usually caused by an infection. A non-infectious cause should be considered if antibiotic treatment is insufficiently effective and disease is recurrent, multifocal or migrating. CASE DESCRIPTION: A 14-year-old girl, an active volleyball player, developed episodes of fever and pain in her right lower leg. MRI showed osteomyelitis in her right tibia. She received prolonged intravenous antibiotic treatment. Shortly after recovery, she developed osteomyelitis in her left lower leg...
2017: Nederlands Tijdschrift Voor Geneeskunde
E L van der Linden, R J Bun, E van Os
BACKGROUND: Mandibular fractures are rare in children. Symptoms of these fractures include preauricular pain and swelling, trismus and pain when opening the mouth, and they are often preceded by a fall on the chin. If the diagnosis is missed they may have serious consequences for the growth and development of the jaw. CASE DESCRIPTION: A 3-year-old boy was referred with a swelling in his left cheek, fever and vomiting. Two days earlier he had fallen on his chin...
2017: Nederlands Tijdschrift Voor Geneeskunde
E L M Op de Coul, I K Joore, A van Sighem, B C J Bom, M Hillebregt, J M Prins, S E Geerlings, J E A M van Bergen
OBJECTIVE: To map regions of the Netherlands with high HIV prevalence for surveillance and prevention purposes. METHOD: Information on numbers of HIV patients receiving clinical care on 31 December 2014 per postcode region was requested from the HIV monitoring foundation (SHM). These details were related to data from Statistics Netherlands on the number of residents per municipal area or district with the aid of a geographic information system (GIS). RESULTS: Distribution mapping showed that ten municipal areas in the Netherlands have an HIV prevalence of 2 or more per 1000 residents aged 15-60 years...
2017: Nederlands Tijdschrift Voor Geneeskunde
A F Cohen
Recently, it was shown that more than 40% of the clinical drug trials in the Netherlands does not reach the stage of publication. Although the non-publication rate of clinical trials seems to have improved compared to previous studies, it is still far from optimal, in particular among phase I trials. In this article the life cycle of clinical drug research is discussed, in order to explain the non-publication rate in the Netherlands and to point out how the publication rate of phase I trials could be improved...
2017: Nederlands Tijdschrift Voor Geneeskunde
C A van den Bogert, P C Souverein, C T M Brekelmans, S W J Janssen, G H Ko√ęter, H G M Leufkens, L M Bouter
The objective of this study was to investigate the occurrence and determinants of non-publication of clinical drug trials in the Netherlands. All clinical drug trials reviewed by the 28 Institutional Review Boards (IRBs) in the Netherlands in 2007 were followed-up from approval to publication. Candidate determinants were the sponsor, phase, applicant, centers, therapeutic effect expected, type of trial, approval status of the drug(s), drug type, participant category, oncology or other disease area, prospective registration, and early termination...
2017: Nederlands Tijdschrift Voor Geneeskunde
P L B J Lucassen, S Postma, T C Olde Hartman, H van Ravesteijn, M J Linssen, J Wolf, D L Gerritsen
An important cause of the high prescription levels of psychotropic medication for psychological symptoms is that these symptoms are assessed according to the same model as applied for physical symptoms, the disease model. This has led to a one-sided medical approach to psychological symptoms. A person-centred approach offers an alternative; the positive aspects of the disease-centred approach are retained and attention for the patient and his/her context become the central focal point for the general practitioner...
2017: Nederlands Tijdschrift Voor Geneeskunde
M N Boersma, J J Nugteren-van Lonkhuyzen, E M van Maarseveen, H A H Kaasjager, A J H P van Riel, D Dekker
Abuse of new psychoactive substances (NPS) and the number of patients presenting to the ER with intoxication are increasing. Treatment may at first sight seem complicated because of limited knowledge of the substance involved, but should be based on a general supportive approach recognising the relatively predictable spectrum of symptoms caused by adrenergic, serotonergic and dopaminergic stimulation. In this article, we discuss the vital elements of this approach and possible complications of NPS intoxication...
2017: Nederlands Tijdschrift Voor Geneeskunde
M C J Knippels, I M M Essers, F J H Magdelijns, D J L van Twist
BACKGROUND: The use of 4-fluoroamphetamine (4-FA) has shown a marked increase, especially because users perceive its effects to be relatively mild. 4-FA is also known as ecstacy-light, but is probably not as light as its name suggests. From April 2017 its use has therefore been forbidden in the Netherlands. CASE DESCRIPTION: In a short time, we saw three patients at our emergency department who had signs of a severe intoxication with 4-FA. A 21-year-old male developed a tonic-clonic seizure, bruxism, mydriasis, and rhabdomyolysis...
2017: Nederlands Tijdschrift Voor Geneeskunde
T M de Kruif, L A van de Laar, N Hagenaars
In October 2016, the Health Council of the Netherlands has published the 'Research that makes you better' report. This report gives an overview of a future scenario in which UMCs (university medical centres) are investing more in research into quality and efficiency of care and prevention. This scenario is based on interviews and a review of the literature. In this article, we quantify biomedical research in the Netherlands and give a summary of the implications of the Health Council proposals. Our conclusion is that there is only a limited correlation between the Dutch research portfolio versus burden of disease and cost of care...
2017: Nederlands Tijdschrift Voor Geneeskunde
M Gijtenbeek, M C Haak
- The mid-pregnancy anomaly scan was introduced into the Netherlands in 2007. The scan is performed at 18- 21 weeks of pregnancy.- The detection rate of open spina bifida is 94%.- In the Netherlands, 60% of all congenital heart defects are diagnosed prenatally compared with 35-40% in other countries. There is a strong relationship between the severity of the heart defect and the detection rate, as more than 95% of all univentricular heart defects are detected.- The detection rate of isolated cleft lip and cleft palate has increased from 32% to 87%...
2017: Nederlands Tijdschrift Voor Geneeskunde
B G Fikkers, H Delwig
Tracheotomy is one of the oldest interventions in medical sciences. It is a procedure that is frequently used in patients who have been admitted to the intensive care unit. Over the last twenty years, the use of the dilation technique has increased in frequency. We believe that the timing of a tracheostoma placement should be evaluated individually for every patient and should always be weighed against the potential risks of an operative intervention. This is illustrated with case reports of four patients with respiratory problems; in the case of one of these patients, the decision was made not to perform tracheotomy, which nonetheless resulted in a favourable clinical outcome...
2017: Nederlands Tijdschrift Voor Geneeskunde
E A van der Rhee, M A Middelkamp-Hup, R Hoekzema
An eight-month-old girl was referred to the dermatologist with a progressive desquamative and purulent eruption on the scalp. Laboratory tests confirmed the diagnosis kerion celsi and the girl was successfully treated with an antimycoticum. Kerion celsi is a deep inflammatory fungal infection on the scalp. Early diagnosis is essential to prevent irreversible hair loss.
2017: Nederlands Tijdschrift Voor Geneeskunde
J P de Boer, G Velders, R Aliredjo, E Scheenjes, T W H Flinsenberg
BACKGROUND: Myomatous erythrocytosis syndrome (MES) is characterised by a combination of polycythaemia, uterus myomatosus and the normalisation of erythrocyte count after hysterectomy. CASE DESCRIPTION: A 58-year-old postmenopausal woman was referred to the gynaecologist with symptoms of vaginal blood loss, increased abdominal circumference and pollakiuria. Physical examination indicated her uterus was enlarged to the size of a 24-week gestation. Endometrial malignancy was excluded and ultrasound showed a myoma...
2017: Nederlands Tijdschrift Voor Geneeskunde
R J Uittenbroek, H P H Kremer, S L W Spoorenberg, S A Reijneveld, K Wynia
OBJECTIVE: To examine the impact of Embrace (Dutch: SamenOud), a new primary care model for community-living people aged over 75 years on perceived quality of care. DESIGN: Randomized controlled trial in 15 general practices in the East Groningen region of the Netherlands. METHOD: In the period January 2012-March 2013, 1456 general practice patients aged 75 years and older were stratified on the basis of self-reporting into 3 risk profiles: 'robust', 'frail' and 'complex care needs', and then randomized to the intervention or the control arm...
2017: Nederlands Tijdschrift Voor Geneeskunde
A Brys, A Wijers, M de Vries, N Bouwman, R Borghans
BACKGROUND: Neuralgic amyotrophy is characterised by pain in the neck or shoulder region, followed by neuropathy of both motor and sensory nerves of the brachial plexus. The incidence of this condition is estimated at 1/1000 per year. In a rare variant of the syndrome, involvement of both phrenic nerves can occur, leading to diaphragmatic paralysis and severe orthopnoea. CASE DESCRIPTION: A 67-year-old woman was referred to us with acute orthopnoea. Imaging studies showed bilateral diaphragmatic paralysis, and electromyography (EMG) confirmed neuropathy of both phrenic nerves...
2017: Nederlands Tijdschrift Voor Geneeskunde
D M Ouweneel, W K Lagrand, B A J M de Mol, J P S Henriques
Temporary mechanical circulatory support is increasingly used, particularly in patients with cardiogenic shock or during high-risk percutaneous coronary interventions. In the last five years there have been numerous developments in this field. Experience has been gained from usage of temporary heart pumps, and new pumps have arrived on the market. Until recently, the intra-aortal balloon pump was the standard treatment for patients with cardiogenic shock; however, results from the latest research into the effectiveness of this pump have rendered it less popular...
2017: Nederlands Tijdschrift Voor Geneeskunde
N Jacobs, F G Huisman
In 2016, it had been exactly half a century ago that Henry Beecher published his article 'Ethics and clinical research' in The New England Journal of Medicine. Today, this article is considered a turning point in the history of medical research ethics. On the occasion of the fiftieth anniversary of this famous article, we are looking back on this turbulent period in the history of medicine.
2017: Nederlands Tijdschrift Voor Geneeskunde
E J Leemhuis, E P J Arnoldus, L H Visser
- Even at a young age, multiple sclerosis often profoundly impacts a patient's daily activities.- Treatment is complicated because disease course is different for each patient.- Early treatment has the best results, in the short term as well as the long term, but the most effective treatments can have severe and sometimes irreversible side effects and are very costly.- It is therefore important to determine the prognosis at an early stage, in order to limit increasing future invalidity with appropriate treatment...
2017: Nederlands Tijdschrift Voor Geneeskunde
M A van Schijndel, L A W Jansen, P J Caarls, F van 't Veer, A I Wierdsma, J D H van Wijngaarden, J A van Waarde, J J van Busschbach
OBJECTIVE: One of the spearheads of psychiatric healthcare in the Netherlands is hospital care for patients with a psychiatric comorbidity. In 2014, the Netherlands Psychiatric Association published ten field standards for Medical Psychiatric Units (MPUs). We catalogued healthcare in the Netherlands on the basis of these field standards. DESIGN: Telephone screening, followed by a questionnaire investigation. METHOD: In the period May-August 2015, psychiatrists in 90 hospitals in the Netherlands were approached by telephone with 4 screening questions...
2017: Nederlands Tijdschrift Voor Geneeskunde
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