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Nederlands Tijdschrift Voor Geneeskunde

Anna D Tulen, Maarten van Wijhe, Hester Korthals Altes, Scott A McDonald, Hester E de Melker, Maarten J Postma, Jacco Wallinga
OBJECTIVE: To quantify the impact of long-standing vaccination programmes on notified cases in the Netherlands. DESIGN: Estimates based on model projections of historical morbidity data. METHOD: We collected and digitised previously unavailable monthly case notifications of diphtheria, poliomyelitis, mumps and rubella in the Netherlands over the period 1919-2015. Poisson regression models accounting for seasonality, multi-year cycles, secular trends and auto-correlation were fit to pre-vaccination periods...
September 20, 2018: Nederlands Tijdschrift Voor Geneeskunde
Rozanne E Tijssen, Gisela M Steenvoorden, Marjolein E de Gruijter, Florence van Hunsel, Martijn Stevens, Jeroen Heidt
Millions of people are vaccinated each year to prevent morbidity and mortality by numerous bacterial and viral infections. Safety of vaccines is an important topic of discussion, especially because of the prophylactic nature of vaccination. Luckily, serious adverse events are rare. However, low incidence results in low awareness, and thus can make identification of these post-vaccination diseases difficult for healthcare workers. In the Netherlands, serious adverse events caused by travel vaccinations are especially rare, because of the low immunisation coverage compared to endemic countries...
September 19, 2018: Nederlands Tijdschrift Voor Geneeskunde
Josje D Schoufour, Jessica C Kiefte-de Jong, Trudy Voortman
OBJECTIVE: We aimed to evaluate the criterion validity of the 2015 food-based Dutch dietary guidelines, which were formulated based on evidence on the relation between diet and major chronic diseases. DESIGN: We studied 9,701 participants of the Rotterdam Study, a population-based prospective cohort in individuals aged 45 years and over. METHOD: Dietary intake was assessed at baseline with a food-frequency questionnaire. For all participants, we examined adherence (yes/no) to fourteen items of the guidelines: vegetables (≥200g/d), fruit (≥200g/d), whole-grains (≥90g/d), legumes (≥135g/wk), nuts (≥15g/d), dairy (≥350g/d), fish (≥100g/wk), tea (≥450mL/d), ratio whole-grains:total grains (≥50%), ratio unsaturated fats & oils:total fats (≥50%), red and processed meat (<300g/wk), sugar-containing beverages (<150mL/d), alcohol (<10 g/d) and salt (≤6g/d)...
September 19, 2018: Nederlands Tijdschrift Voor Geneeskunde
Paul J Hengeveld, Mette D Hazenberg, Maarten H Biezeveld, Martine F Raphael
Reactive thrombocytosis (RT; thrombocyte count: > 450 x 109/l) is a condition in which an increase in platelet production, stimulated by cytokines in the bone marrow, is secondary to some condition or circumstance. Although RT does often occur in children, the risk of thromboembolic complications is negligible in this group if they have no other risk factors for thrombosis. In the absence of additional risk factors for thrombosis it seems as though RT in adults does not predispose them to thromboembolic complications either...
September 17, 2018: Nederlands Tijdschrift Voor Geneeskunde
Geert H Groeneveld, Willy J Spaan, Wim van der Hoek, Jaap T van Dissel
The 2017/2018 influenza season was severe and lasted twice as long as usual. Hospitals struggled to meet the demand for care. In addition to a high number of patients with flu and its complications, other factors played a role. These included absenteeism of informal caretakers and professional home care staff due to having flu themselves, and added strain on hospital capacity due to flu-related sick leave of hospital staff. A minority of the latter group is vaccinated annually against influenza. The authors of this article argue that all healthcare providers should take the yearly influenza vaccination...
September 6, 2018: Nederlands Tijdschrift Voor Geneeskunde
Ruud A F Verhees, Wybo Dondorp, Carel Thijs, G J Dinant, André Knottnerus
The effectiveness of influenza vaccination in the elderly has long been a topic of debate, fueled by the absence of direct evidence on its effect on mortality. It is argued that new placebo-controlled trials should be undertaken to resolve this uncertainty. However, such trials may be ethically questionable. We provide an overview of the ethical challenges of an influenza vaccine efficacy trial designed to evaluate mortality in the elderly. An important condition in the justification of a trial is the existence of genuine uncertainty regarding the answer to a research question...
September 6, 2018: Nederlands Tijdschrift Voor Geneeskunde
Miquel B Ekkelenkamp, C H van Werkhoven, Patricia C J Bruijning-Verhagen, Marc J M Bonten
Based on current research, there are no valid reasons to assume that influenza vaccination of people aged 60 and over without any other medical indications, in the context of the national programme of influenza prevention, leads to significant, relevant and cost-effective health benefits. In view of the pressure on health care budgets and the decreasing social willingness to vaccinate, it is of great and urgent importance that the actual effect of influenza vaccination is quantified in a double-blind placebo-controlled randomized trial (RCT) with relevant outcome measures, which does not suffer from the methodological shortcomings of the few previous studies...
September 6, 2018: Nederlands Tijdschrift Voor Geneeskunde
Josine E Verhoeven, Judith Verduijn, Robert A Schoevers, Albert M van Hemert, Aartjan T F Beekman, Brenda W J H Penninx
OBJECTIVE: To investigate whether the course of depression changes when (a) follow-up duration is longer and (b) in addition to depression other mood and anxiety disorders are considered as outcome measures. DESIGN: Longitudinal observational cohort study. METHOD: We selected patients from the Netherlands Study of Depression and Anxiety (NESDA) who had active depression at baseline (n=903) and for whom data from the 2, 4 and/or 6 year measurements were available...
September 6, 2018: Nederlands Tijdschrift Voor Geneeskunde
Gert Olthuis, Priscilla Hanssen, Jelle van Gurp
Although vaccinating seems self-evident, the immunization coverage in the Netherlands is decreasing. This decrease is often attributed to a lack of knowledge amongst the public. We argue, however, that it is rather a lack of trust that drives this reduction in uptake. In this article we discuss the role that trust, or rather a lack thereof, plays in vaccination refusal. We underpin our argument with a recent exploration of the way in which vaccination programmes are framed in newspaper articles and on internet forums...
September 6, 2018: Nederlands Tijdschrift Voor Geneeskunde
Anouk van Berkel, Adrie Seldenrijk, H Knegtering, P R Bakker, H G Ruhé, C Kramers
No abstract text is available yet for this article.
September 5, 2018: Nederlands Tijdschrift Voor Geneeskunde
Michel Abdel Malek, Tessa Smissaert van de Haere, Ruud Loffeld
A 74-year-old man presented to the Emergency Department after a fall from a ladder. Plain radiographic screening of the lumbar spine revealed an unanticipated curvilinear, oval-shaped air configuration in the pelvis. Computed tomography of the lumbar spine showed air within the bladder wall and lumen. Urine cultures were positive for Escherichia coli. The patient was discharged after bladder drainage and empiric antibiotic treatment.
September 3, 2018: Nederlands Tijdschrift Voor Geneeskunde
Richard P Koopmans
There is some controversy regarding the role of and time devoted to so-called basic sciences in the medical curriculum. In this article, the author argues that nowadays basic sciences are a far less important element of the medical curriculum than in the past, and that in time they will likely be phased out completely. Arguments put forward are the changing role of the medical doctor, evidence that general clinical reasoning skills do not exist, and that the contrary assumption has led to havoc. He concludes that the removal of basic sciences from the medical curriculum will be substituted by teaching of consultation skills, psychology and guideline application...
August 30, 2018: Nederlands Tijdschrift Voor Geneeskunde
Ingrid M Nijholt, Micah L A Heldeweg, Johanna Schönrock-Adema, Paul L P Brand
OBJECTIVE: To investigate how quality control of clinical placements in the Netherlands is organised, which tools are available for this purpose, and what Dutch clinical placement students think about current clinical placement assessment. DESIGN: Document analysis, literature search and questionnaire. METHOD: In 2017, we asked all 8 medical schools to share their procedures and tools for assessing clinical placement quality with us. We searched various databases to find all published tools developed to measure clinical placement quality...
August 30, 2018: Nederlands Tijdschrift Voor Geneeskunde
Leonie M Bultje, Elize C Newsum
In teaching physical examination as part of our medical training, we have recently started using a digital stethoscope that is connected to external speakers. The use of speakers enables students to listen to auscultation in real-time. This facilitates the direct interpretation, explanation and discussion of auscultatory findings. We expect that this interactive method of teaching will improve the auscultatory skills of students.
August 30, 2018: Nederlands Tijdschrift Voor Geneeskunde
Ageeth N Schonewille-Rosman, Régine P M Steegers-Theunissen, Eric A P Steegers
Good preconception care does not only benefit the health of the mother to be and her child during pregnancy, but also their health in later life. In the Netherlands, preconception care is not standard care. Preconception care aims to prevent biomedical, behavioural and social risks by taking steps before conception to reduce the likelihood of these risks materialising. It also helps mothers to be to make informed reproductive choices. Caregivers and the public are not aware enough of the extent in which the first 10 weeks of pregnancy affect the health of the infant and of the child later in life...
August 30, 2018: Nederlands Tijdschrift Voor Geneeskunde
Jan Hindrik Ravesloot
Studying the pre-clinical foundations of the medical profession sharpens the mind, improves critical thinking skills, builds academic stamina, and stimulates scientific curiosity. However, incorporation of the ever-growing clinical knowledge body into medical curricula jeopardizes the time undergraduate medical students are exposed to covering the basic sciences. In addition, clinical practice guidelines and clinical protocols lessen the importance of fostering critical thinking skills in our students. Inasmuch as mastering basic sciences demands a substantial time consuming intellectual effort, medical students prefer memorization and reproduction tasks to analysing challenging basic science questions...
August 30, 2018: Nederlands Tijdschrift Voor Geneeskunde
Pieter J M Stallen, Michiel Marlet
What is preferable for a patient who has requested euthanasia: self-administration of a lethal drink (assisted dying), or to have a drug administered intravenously (euthanasia)? We analysed data from a total of 226 patients who had been helped with assisted dying. In 86% of the cases (195 patients) death occurred within 30 minutes. Thus, the predictability of the process of dying after drinking the lethal drink is relatively high. This implies that other aspects can be taken into consideration when making the choice between euthanasia and assisted dying, including the patient's own responsibility and the impact the method will have on relatives...
August 30, 2018: Nederlands Tijdschrift Voor Geneeskunde
Shaho Hasan, Pieta Krijnen, M Elske van den Akker-van Marle, Inger B Schipper, Kees A Bartlema
OBJECTIVE: To measure the effects of a medical scribe in an orthopaedic trauma surgery outpatient clinic on consultation time, patient satisfaction, doctor satisfaction and costs. DESIGN: Cross-sectional study. METHOD: At a level-1 trauma centre in the Netherlands, all standard outpatient trauma consultations were performed either with or without a medical scribe, for a period of 10 weeks. Length of consultation time was defined as the time from commencement of the consultation until the moment the electronic health record had been completely filled out and checked by the surgeon...
August 30, 2018: Nederlands Tijdschrift Voor Geneeskunde
Michèle van Vugt, Gabor E Linthorst
All Dutch universities encourage their medical students to follow part of their Bachelor's or Master's degree abroad. In doing so, students encounter other cultures and see medicine from a global perspective, including possible inequalities in health care access. Though it is well-known that these experiences often have a profound impact on an individual student, little is known as to whether this also leads to better future physicians. More importantly, travelling to certain areas where endemic infections occur poses an additional risk...
August 30, 2018: Nederlands Tijdschrift Voor Geneeskunde
Quirijn de Mast, Rogier Thurlings, Jaap Ten Oever
Pneumocystis jiroveci pneumonia (PJP) is a much-feared complication of the use of immunosuppressive drugs. There is no current consensus on the indications for PJP prophylaxis in patients with rheumatological diseases who are receiving higher-dose glucocorticoid treatment over a prolonged period. The decision on whether or not to administer prophylaxis depends primarily on the Number Needed to Treat (NNT) vs the Number Needed to Harm (NNH) of trimethoprim/sulfamethoxazole (TMP/SMX) or other forms of prophylaxis...
August 30, 2018: Nederlands Tijdschrift Voor Geneeskunde
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