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[Fracture prevention: breaking with the guideline?] [骨折预防：打破准则？］
Nederlands tijdschrift voor geneeskunde Pub Date : 2024-11-14
Thomas Merlijn, Petra J M Elders, Henriëtte E van der Horst
{"title":"[Fracture prevention: breaking with the guideline?]","authors":"Thomas Merlijn, Petra J M Elders, Henriëtte E van der Horst","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We have evaluated the merits and scientific underpinning of two different forms of fracture prevention. The first is the fracture liaison service(FLS), in which persons aged 50 years or older who have suffered a fracture are assessed and treated. The second is a stepped screening program for women aged 65 years or older, utilizing questionnaires and bone densitometry to identify those with the highest fracture risk for treatment. The FLS approach is based on indirect evidence and has not been studied in randomised studies. There is a lack of evidence for effectiveness in the younger age group of 50-65 years. A meta-analysis of three randomised studies in older women showed a 20% risk reduction of hip fractures. We suggest that FLS should focus on the group >65 years and that an additional once in a life time fracture risk screening program in women of 75-80 year should be considered.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"168 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623903","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
[Transmural collaboration in palliative care: a feasibility study into structured transfer of care for acutely hospitalized patients]. [姑息关怀的跨部门合作：对急性期住院病人进行结构化转移关怀的可行性研究]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2024-11-14
Tamara van Schaik, Filip Y F de Vos, Toosje A C H Valkenburg, Everlien de Graaf, Saskia C C M Teunissen
{"title":"[Transmural collaboration in palliative care: a feasibility study into structured transfer of care for acutely hospitalized patients].","authors":"Tamara van Schaik, Filip Y F de Vos, Toosje A C H Valkenburg, Everlien de Graaf, Saskia C C M Teunissen","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Care transitions are common in the last months of life and continuity of information and care is at risk when unplanned admissions are necessary. To mitigate the risk of inappropriate care, a transmural care pathway was developed, that includes active involvement of a patient's general practitioner during hospitalization.</p><p><strong>Design: </strong>Multiple-method feasibility study in an academic hospital and affiliated general practices from July to December 2022. Data collection involved a survey and semi-structured interviews. Analysis encompassed descriptive statistics and thematic analysis.</p><p><strong>Results: </strong>Patients (n = 41) with cancer who experienced an unplanned hospital admission were included. The study shows that personal contact and the use of a scripted protocol during care transitions improves collaboration between healthcare professionals. Balancing attention between the physical, psychological, social, and spiritual dimensions of patients remains a challenge.</p><p><strong>Conclusion: </strong>Personal telephone contact with a patient's GP during hospital admission and discharge contributes to continuity of information and care.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"168 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623926","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
[An imprint in the liver]. [肝脏中的印记］
Nederlands tijdschrift voor geneeskunde Pub Date : 2024-11-13
Pieter H Sloos, Jan J J de Vries, Hendrik A Marsman
{"title":"[An imprint in the liver].","authors":"Pieter H Sloos, Jan J J de Vries, Hendrik A Marsman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 35-year-old woman with a history of uterine myomas, presented with a symptomatic liver lesion. It was initially suspected to be an atypical hepatic adenoma. However, during surgery, it was discovered that the lesion was a myoma attached to the thoracic wall, likely a remnant of previous uterine myomas treatment.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"168 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623902","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
[Hereditary thrombophilia; whom to test?] [遗传性血栓性疾病；谁来检测？］
Nederlands tijdschrift voor geneeskunde Pub Date : 2024-11-11
Kyra N Smit, Henrike M Hamer, Irene L M Klaassen, Joost C M Meijers, Michiel Coppens
{"title":"[Hereditary thrombophilia; whom to test?]","authors":"Kyra N Smit, Henrike M Hamer, Irene L M Klaassen, Joost C M Meijers, Michiel Coppens","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Patients with thrombophilia show a higher incidence of VTE due to a disturbance in the hemostatic system. Hereditary thrombophilia can be identified by laboratory diagnostics, however most guidelines advise against thrombophilia testing in the majority of the patients with VTE, since the outcome rarely affects clinical decisions for the treatment. In this article we describe two cases in which hereditary thrombophilia testing could be considered. Thrombophilia testing should only be performed in specific patients, where it is already decided beforehand how the outcome will guide future decision making.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"168 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623905","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 alignment of efficiency studies with clinical guidelines. Where are the opportunities for improvement?] [效率研究与临床指南的一致性。改进的机会在哪里？］
Nederlands tijdschrift voor geneeskunde Pub Date : 2024-11-05
Gerjanne Vianen, Romy Zwarts-van de Putte, Mirte Brom, Teus van Barneveld
{"title":"[The alignment of efficiency studies with clinical guidelines. Where are the opportunities for improvement?]","authors":"Gerjanne Vianen, Romy Zwarts-van de Putte, Mirte Brom, Teus van Barneveld","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To provide insight as well as challenges and opportunities to more effectively align Dutch efficiency research with clinical guidelines.</p><p><strong>Design: </strong>Evaluation research METHOD: The alignment with existing clinical guidelines regarding medical specialist care was analyzed for 111 efficiency studies funded by the Dutch national health care research programme, and completed between 2018-2023.</p><p><strong>Results: </strong>Ninety percent of the studies could be linked to a clinical guideline. A limited number (19%) were actually integrated in a guideline, whereas 22% of the studies did not (sufficiently) align with the related questions from the clinical guidelines.</p><p><strong>Conclusion: </strong>By providing insight into the processes, it becomes clear that choices must be made in various stages. The results show that the alignment of efficiency research with clinical guidelines is (still) suboptimal. Close collaboration between ZonMw, the Knowledge Institute and relevant stakeholders is therefore essential. The goal is to optimize the processes and make current, well-defined knowledge quickly and effectively available for clinical practice.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"168 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623924","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
[Are responsibilities conveyable through a feedback letter?] [是否可以通过反馈信传达责任？］
Nederlands tijdschrift voor geneeskunde Pub Date : 2024-10-29
A C Hendriks, Wouter de Ruijter
{"title":"[Are responsibilities conveyable through a feedback letter?]","authors":"A C Hendriks, Wouter de Ruijter","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A feedback letter from a medical specialist to a general practitioner above all contains relevant medical information. It is not meant to impose new diagnostic and treatment responsibilities on a general practitioner. Yet, the recommendations a feedback letter may contain are not without obligation. The general practitioner is expected to consider whether he will implement the recommendations or not. It is important to realise that general practitioners do not always read long feedback letters. In addition, it is recommended that medical specialists and general practitioners do not refrain from contacting each other, particularly in case of important diagnostic or treatment issues. A mere feedback letter may be insufficient to convey relevant information.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"168 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504451","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
[Shortage antipsychotic medication supply hits vulnerable patients most]. [抗精神病药物供应短缺对弱势患者打击最大]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2024-10-29
S A Moerkens, Bettina Jacobsen, Martijn A J TeStroet
{"title":"[Shortage antipsychotic medication supply hits vulnerable patients most].","authors":"S A Moerkens, Bettina Jacobsen, Martijn A J TeStroet","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Medication shortages in The Netherlands are getting worse since 2019, with numbers increasing every year. In September 2023, during our work in a psychiatric outpatient clinic, we were confronted with the consequences of these rising numbers. There was an acute shortage of penfluridol, an antipsychotic medication. Soon thereafter, another shortage occurred. The intramuscular depot of olanzapine (Zypadhera) was not available over a long period of time. Shortages of antipsychotic medication supply could have severe consequences. Stopping or switching medication can lead to psychotic decompensation. During a psychotic episode, a patient can lose his mental stability and all facets of life can be affected. Therefore, the medication shortages can have a life altering effect. As healthcare workers we feel obliged to report about the consequences of the severity of the rising number of medication shortages and highlight the consequences of the vulnerability of psychiatric patients.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"168 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504454","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
[Fatigue]. [疲劳]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2024-10-28
Peter Lucassen, Sonja van Ockenburg, Rijk Gans, Judith Rosmalen, Tim Olde Hartman
{"title":"[Fatigue].","authors":"Peter Lucassen, Sonja van Ockenburg, Rijk Gans, Judith Rosmalen, Tim Olde Hartman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Many patients with fatigue do not visit a physician. In patients who do consult the general practitioner, the cause of their fatigue is explained in about a quarter: 8 percent has a somatic cause while psychosocial causes explain 16 percent. In about three quarters the cause of fatigue remains unexplained. Because of the low prevalence of somatic causes the general practitioner will be reluctant to perform additional examinations but a thorough physical examination is essential. In patients with a longer duration of fatigue (> 6 months) it is indicated to expand inquiries. This starts with extending history taking in the direction of consanguinity and hereditary diseases. More comprehensive blood tests and investigation of sleep are important further steps. Referral to a specialist is essential as specialists are more familiar with scripts of rare diseases. The prognosis of longer lasting fatigue is bad, especially in the case of fatigue meeting criteria for ME/CFS. Treatment of longer lasting fatigue could compromise of psycho-education, exercise and specific therapies for sleeping disorders.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"168 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504453","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 blindness in a patient with metformin-associated lactic acidosis]. [二甲双胍相关性乳酸中毒患者急性失明]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2024-10-24
Ramsha Iqbal, Brigitta Scheerman, Niels Hakkens, Stephanie Koster, Rob J L Klaassen, Jacob W Bosma
{"title":"[Acute blindness in a patient with metformin-associated lactic acidosis].","authors":"Ramsha Iqbal, Brigitta Scheerman, Niels Hakkens, Stephanie Koster, Rob J L Klaassen, Jacob W Bosma","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Lactic acidosis is a rare metabolic complication that can occur in patients with diabetes mellitus type 2 who use metformin. We discuss a 79-year old woman with metformin-associated lactic acidosis (MALA) and acute kidney injury based on gastroenteritis. Patient reported acute blindness which in literature is described as a rare presentation of a metabolic acidosis (regardless of its underlying cause). Immediate treatment with hemodialysis led to improvement of the acidosis and complete recovery of the vision. It is important that patients who use metformin are instructed to consult their health care provider and/or discontinue metformin in case of intercurrent diseases.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"168 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546465","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
[Fat embolism syndrome after a lateral tibial plateau fracture, a case report]. [胫骨外侧平台骨折后脂肪栓塞综合征，病例报告]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2024-10-23
Joanne Van Bastelaere, Stephanie Vanden Bossche, Eva Janssens
{"title":"[Fat embolism syndrome after a lateral tibial plateau fracture, a case report].","authors":"Joanne Van Bastelaere, Stephanie Vanden Bossche, Eva Janssens","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Fat Embolism Syndrome (FES) is a condition associated with fractures of long bones and pelvic fractures. In this case report, FES was diagnosed in a 37-year-old man with a lateral tibial plateau fracture who developed respiratory and neurological symptoms shortly after hospitalization. Brain MRI findings were suggestive of central fat emboli.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"168 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504452","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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