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[International criticism of the Dutch Protocol; time to change Dutch pediatric gender care and its guideline]. [对《荷兰议定书》的国际批评；是时候改变荷兰儿科性别护理及其指南了]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-05-29
Jilles Smids
{"title":"[International criticism of the Dutch Protocol; time to change Dutch pediatric gender care and its guideline].","authors":"Jilles Smids","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The thorough Cass review into care for adolescents with gender dysphoria concludes that the evidence is insufficient to justify routine treatment with puberty blockers and cross-sex hormones. The review recommends a thorough exploration of the gender problems, and holistic care involving psychosocial interventions to reduce distress and improve global functioning, prioritizing non-medical interventions. Dutch pediatric gender clinics emphasize that such holistic approach is the standard in the Netherlands. However, current Dutch guidelines do not recommend this. Concerningly, the current guideline revision intends to build on the consensus-based and otherwise problematic Standard of Care 8 from the World Professional Association for Transgender Health. This paper argues for evidence-based (interim) guidelines that describe and recommend holistic gender care along the lines of the Cass report. Hormones should be the last resort for minors with gender dysphoria.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144160028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
['I was murdered': Cotard's syndrome due to retrotonsillar abscess]. [‘我被谋杀了’：扁桃体后脓肿引起的科塔尔综合症]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-05-28
Marte van der Horst, Nini de Boer, Michelle Lancee, Rob van Ojen, Douwe Dekker, Fedor van Houwelingen
{"title":"['I was murdered': Cotard's syndrome due to retrotonsillar abscess].","authors":"Marte van der Horst, Nini de Boer, Michelle Lancee, Rob van Ojen, Douwe Dekker, Fedor van Houwelingen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cotard's syndrome is a rare and severe neuropsychiatric disorder characterized by nihilistic delusions, where patients believe they are dead or do not exist. It's often associated with depression or schizophrenia but may also occur secondary to somatic conditions such as epilepsy, brain tumors, and neurodegenerative diseases. This case involves a 30-year-old man with no prior psychiatric history, who was brought to the emergency department due to confusion and the delusion that he was dead. Examination revealed a retrotonsillar abscess. Although the patient initially lacked classic delirium features such as disorientation and hallucinations, he later developed cognitive and behavioral disturbances, leading to a diagnosis of delirium. Treatment with antibiotics and antipsychotics resulted in rapid clinical improvement and remission of the Cotard delusion. This case highlights the importance of considering delirium in the differential diagnosis of acute psychosis, even in atypical presentations, and emphasizes the need for integrated medical and psychiatric care.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Quality of life and functional outcomes in patients with rectal carcinoma]. [直肠癌患者的生活质量和功能结局]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-05-27
Alexander J Pennings, Geraldine R Vink, Sander van Kuijk, Jarno Melenhorst, Geerard L Beets, Anne M May, Stephanie O Breukink
{"title":"[Quality of life and functional outcomes in patients with rectal carcinoma].","authors":"Alexander J Pennings, Geraldine R Vink, Sander van Kuijk, Jarno Melenhorst, Geerard L Beets, Anne M May, Stephanie O Breukink","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates the impact of improved diagnostics and treatments on health-related quality of life (HRQoL) and functional outcomes in patients with rectal carcinoma in the Netherlands.</p><p><strong>Design: </strong>Data from the Prospective National ColorRectal Carcinoma cohort (PLCRC) were analysed to compare trends in HRQoL and functional outcomes between 2014 and 2019.</p><p><strong>Method: </strong>HRQoL and functional outcomes were assessed with validated patient questionnaires (EORTC-QLQ-C30, CR29, LARS score). Longitudinal and multivariate analyses were used to analyse changes over time.</p><p><strong>Results: </strong>Patients in 2019 had better HRQoL scores, fewer adverse events and improved anorectal function compared with 2014. Physical, role and social functioning improved significantly, while complaints such as fatigue and pain decreased. Fewer patients underwent invasive treatments or had a stoma.</p><p><strong>Conclusion: </strong>Innovations such as population screening and less invasive treatments led to better HRQoL. Less complex therapies contributed to fewer side effects and better recovery. Further progress is expected through personalised care and innovative therapies.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144160071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[AI in mental healthcare: hope or hype?] 人工智能在精神卫生领域：希望还是炒作？］
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-05-22
Katherine C Bassil, Edwin van Dellen
{"title":"[AI in mental healthcare: hope or hype?]","authors":"Katherine C Bassil, Edwin van Dellen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Artificial Intelligence (AI) holds promise for addressing significant challenges in mental healthcare, such as workforce shortages, waiting lists, and the need for personalized diagnostics and treatments. However, current high expectations contrast with the complexities revealed by research on clinical implementations. This paper critically examines two clinical applications of AI in mental healthcare: clinical decision support and mental health chatbots. AI-driven decision support tools, despite their capacity to predict treatment outcomes, face ethical and practical challenges, including fairness concerns, limited outcome measurability, and patient perspectives often overlooked during development. Similarly, mental health chatbots, while enhancing accessibility and supporting therapeutic processes, raise concerns regarding patient autonomy, accountability, and safety. Increasing cases of AI chatbot misuseleading toharmful consequences highlight the need for robust ethical guidelines and rigorous validation before clinical implementation. AI's integration in psychiatry thus requires careful consideration of ethical implications, patient-centered design, and recognition of AI's limitations to ensure improvements genuinely enhance patient care.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[A man with periorbital erythema]. [患有眼眶周围红斑的人]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-05-21
Thirza G Peschar, Nicole V C M Koot
{"title":"[A man with periorbital erythema].","authors":"Thirza G Peschar, Nicole V C M Koot","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cold urticaria is a rare subtype of physical urticaria. It is often mistaken for other common conditions, despite being relatively easy to treat. We present the case of a 68-year-old man who developed cold urticaria.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[The right of not knowing: an intercultural palliative conversation]. [不知道的权利：跨文化缓和对话]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-05-21
Rienke A Fijn, Louise J Blok, Wendy M van der Deure
{"title":"[The right of not knowing: an intercultural palliative conversation].","authors":"Rienke A Fijn, Louise J Blok, Wendy M van der Deure","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Communication in palliative care can be challenging when there are significant differences in the norms and values of patients and healthcare providers. In this article, we illustrate a case involving a 63-year-old woman who was admitted to the hospital due to abdominal pain caused by the progression of her metastatic melanoma. The patient was unaware of her metastatic melanoma, as this had been concealed from her by her daughter for protective reasons. During the admission, an extraordinary conversation took place to inform the patient about the diagnosis and her future prospects, in accordance with the Dutch Medical Treatment Agreement Act (WGBO). In this article, we discuss this conversation, Dutch legislation and regulations, and provide an overview of recent literature on the disclosure of diagnoses in different countries and cultures. We also discuss the TOPOI model in more detail, offering tools for healthcare professionals on how to approach intercultural conversations in palliative care.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Bicycle accidents]. 自行车事故。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-05-20
William L M Kramer, Loes F J Walraven, Joukje van der Naalt, Daphne Beemsterboer
{"title":"[Bicycle accidents].","authors":"William L M Kramer, Loes F J Walraven, Joukje van der Naalt, Daphne Beemsterboer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Injuries as a result from bicycle accidents occur frequently in the Netherlands, annually 76.000 persons. In this article we focus on the consequences for daily practice in ten questions on this subject. Different injuries per category of bicycle (e-bike, fat-bike, regular bike) are addressed, with focus on eventual red flags for injuries that can potentially be missed in the acute phase by general practitioners or emergency physicians. Also, information on risk factors for participation in traffic, specifically for older persons are discussed and preventative measures to reduce the risk of injuries while participating in traffic by bicycle.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"69 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Acute respiratory distress after a cycling accident]. [自行车事故后急性呼吸窘迫]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-05-19
Lynn M M A van den Broek, Jarno W J Huijs, Rémy L M Mostard
{"title":"[Acute respiratory distress after a cycling accident].","authors":"Lynn M M A van den Broek, Jarno W J Huijs, Rémy L M Mostard","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We discuss negative pressure pulmonary edema by presenting a rare case of a 42-year-old male with no relevant medical history who presented with hypoxemia following a high-speed fall from his bicycle. Evaluation with chest X-ray and CT-scan revealed bilateral perihilar consolidations and ground glass opacifications. There was no evidence of a pneumothorax or rib fractures. Other diagnoses were ruled out and the patient was diagnosed with negative pressure pulmonary edema, most likely caused by a Müller maneuver during the accident. This condition, which can also be caused by laryngospasms after detubation, results from a sudden increase in negative intrathoracic pressure, leading to pulmonary capillary pressure increase and fluid extravasation. Treatment consisted of oxygen therapy, rapid improvement of symptoms and resolution of radiological abnormalities was present within 24 hours. This article highlights the importance of considering negative pressure pulmonary edema in patients presenting with acute hypoxemia after trauma and detubation.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Biomarker guided antibiotic stewardship in community acquired pneumonia]. [生物标志物引导的社区获得性肺炎抗生素管理]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-05-14
Ruud Duijkers, Marc J M Bonten, Wim G Boersma
{"title":"[Biomarker guided antibiotic stewardship in community acquired pneumonia].","authors":"Ruud Duijkers, Marc J M Bonten, Wim G Boersma","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether the duration of antibiotic therapy in patients with CAP can be reduced using a biomarker-guided algorithm.</p><p><strong>Design: </strong>Randomized controlled multicentre study.</p><p><strong>Method: </strong>A total of 468 non-ICU patients with CAP were randomized after 2-3 days into three groups (ratio 1:1:1): standard treatment, PCT-guided treatment, and CRP-guided treatment. The primary outcome was the total number of days on antibiotic treatment until day 30. Secondary outcomes included new antibiotic prescriptions, time to clinical stability, length of hospital stay, and 30-day mortality.</p><p><strong>Results: </strong>The mean age of 468 participants was 67 years, and a potential pathogen was identified in 64% of cases. The total number of days on antibiotic treatment was reduced by 30% in the CRP group (4 vs. 7 days; <i>p</i> < 0.001) and by 22% in the PCT group (5.5 vs. 7 days; <i>p</i> < 0.001). No significant differences were observed in secondary outcomes between the standard treatment and biomarker-guided treatment groups.</p><p><strong>Conclusion: </strong>Both CRP- and PCT-guided algorithms reduce the duration of antibiotic use in non-ICU patients with CAP. No differences were observed between the three groups in terms of additional antibiotic prescriptions, length of hospital stay, or mortality.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Overweight and obesity in children: a crucial role for GPs]. [儿童超重和肥胖：全科医生的关键作用]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-05-08
Maxime A M van der Velden, Patrick J E Bindels, Marienke van Middelkoop
{"title":"[Overweight and obesity in children: a crucial role for GPs].","authors":"Maxime A M van der Velden, Patrick J E Bindels, Marienke van Middelkoop","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>General practice is a unique setting to identify overweight and obesity in children. General Practitioners (GPs) can play an important role to signal and managing overweight and obesity in children. However, GPs experience various barriers such as limited time, uncertainty about the parents' reaction and there are ambiguities about the referral options. GPs emphasized that they are in need of supportive tools to fulfill this role. Parents indicate that they are open to a conversation with the GP about their child's weight, provided that the GP is honest and respectful. In co-creation with GPs and parents a supportive tool for GPs was developed. The tool Kindopgewicht.nl consists of a child's specific BMI-calculator, weight-related conversation techniques and an intervention map with an overview of available referral options. This tool should support GPs to identify, address and refer children with overweight and obesity in daily practice.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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