Nederlands tijdschrift voor geneeskunde最新文献

{"title":"[Surgery in older patients].","authors":"Harmke A Polinder-Bos, Suzanne Festen, Didy E Jacobsen, Barbara L van Leeuwen, Hanneke van der Wal-Huisman, Monique G Huisman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Reflecting on the case of a frail older patient with a complicated postoperative course, we highlight points for optimising care for older patients. Preoperative frailty screening is imperative. When frailty is suspected, a comprehensive geriatric assessment (CGA) is needed to guide treatment decisions and to detect risks for a complicated course, possibly amenable to optimisation. The current health status and treatment goals of the patient, together with estimated risks and benefits of a surgical procedure should be explored and weighted. Alternative treatments should be considered, as surgeons often underestimate the negative impact of a surgical procedure in older patients. The development of postoperative geriatric syndromes greatly influences hospital stay and long-term outcomes. Be aware of tunnel vision and discuss doubts, if present either in physicians or patients. In case of a prolonged course, re-evaluation with a CGA and multidisciplinary discussions, including nurses, are valuable in order to provide tailored treatment.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720353","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}

{"title":"[Virtual reality in medical education; experiences with an obstetric training scenario].","authors":"Esmee N de Jong, Angelique J C M van Dongen, Jeroen van Dillen, Machteld Dronkers","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Virtual Reality (VR) is increasingly applied in medical education due to its potential to provide students realistic and safe training scenarios. This article describes the development and evaluation of an obstetric VR scenario for medical education. In this setting, students acquire knowledge and practice decision-making, interprofessional communication, and working under time pressure within a simulated real-life scenario. Evaluation indicates that 90% of the students appreciate the educational value of the VR module. Although both students and teachers are enthusiastic about the VR's potential, development involves significant challenges and initial investment costs. In terms of cost-effectiveness, the module appears to be a sustainable educational solution in the long term. Key challenges include selecting suitable scenarios, limited adaptability of the scenario after implementation and addressing logistical requirements. Despite these limitations, this study concludes that VR is a valuable addition to medical education, with impact on students' skills and knowledge.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605718","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}

{"title":"[How can you help a victim of intimate partner violence? Recognition, discussion and action to prevent fatal outcomes].","authors":"Marie-José van Hoof, Sander van Arum, G A I Avontuur","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Coercive control is a widespread globally prevalent and often missed pattern of intimate partner violence (IPV) that increases the risk of physical disease and mental illness tremendously for its victims, usually women and children. Besides it can lead to femicide and infanticide when red flags are being ignored. Here we describe an illustrative case. We mention several aspects of the IPV pattern of coercive control which are relevant, which should awaken any doctor or paramedic to ask the right questions when comparable patients present themselves. Specific characteristics such as extreme fear of the perpetrator, stalking by the perpetrator or by proxy, and threats of suicide or homicide are red flags for a seriously heightened risk for femicide. Improved recognition and diagnostics, discussing the findings and situation with the patient and taking action for safety and ending violence in collaboration with other professionals and institutes could help prevent femicide and infanticide.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605717","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}

{"title":"[Atelectasis caused by mucus stasis].","authors":"Margot van Spronsen, Michel Timmerman, Frederike Oomen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 58-year-old female presented at the emergency department with dyspnea. Laboratory and X-ray analyses showed eosinophilia and a partial atelectasis of the left lung, respectively. Bronchoscopy demonstrated mucus plugs. Following bronchoscopy, intubation was needed because of acute respiratory failure. Biochemical and microbial tests confirmed the diagnosis allergic bronchopulmonary aspergillosis. Complete recovery was achieved after treatment with prednisone and voriconazole.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"168 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605756","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}

{"title":"[Family planning decision-making in relation to psychiatric disorders in women: a qualitative focus group study].","authors":"Shahenda A I H Ahmad, Jorina Holtrop, Monique J M van den Eijnden, Nini H Jonkman, Maria G van Pampus, Odile A van den Heuvel, Birit F P Broekman, Noralie N Schonewille","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Recent studies revealed an elevated likelihood of unintended pregnancies among women with psychiatric disorders compared to their counterparts without such vulnerability. Despite the importance of understanding family planning decision-making in this group, qualitative inquiries are lacking. This study explored family planning decisions among women with psychiatric disorders.</p><p><strong>Methods: </strong>Utilizing a qualitative approach, three focus group discussions were conducted with purposive sampling: women with a history of unintended pregnancies (N = 3), women without children (N = 5), and women with a history of intended pregnancies (N = 9), all of whom had self-reported psychiatric disorders. Using thematic framework analysis, we investigated the themes \"Shadow of the past,\" reflecting past experiences, and \"Shadow of the future,\" reflecting future imaginaries, building upon the existing \"Narrative Framework.\"</p><p><strong>Results: </strong>The Narrative Framework formed the foundation for understanding family planning among women with psychiatric disorders. The retrospective dimension of focus group discussions provided opportunities for reflective narratives on sensitive topics, revealing emotions of regret, grief and relief. Childhood trauma, adverse events, and inadequate parenting enriched the \"Shadow of the past\". The \"Shadow of the present\" was identified as a novel theme, addressing awareness of psychiatric disorders and emotions toward psychiatric stability. Social influences, stigma, and concerns about transmitting psychiatric disorders shaped future imaginaries in the shadow of the future.</p><p><strong>Conclusions: </strong>This study enlightens how family planning decision-making in women with psychiatric disorders might be complex, as marked by the enduring impact of past experiences and societal influences in this sample. These nuanced insights underscore the necessity for tailored support for women with psychiatric disorders.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605646","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}

{"title":"[Autism diagnosis at an early or late age: need for more objective assessment].","authors":"Sander Begeer, Mayca Ten Haaf, Wouter G Staal","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Autism is classified based on the behavior and development of a child or adult. Subjective assessment plays a significant role during the diagnostic process. Recently, various methods have been developed to enhance diagnostic procedures with more objective instruments. By reviewing recent scientific literature, clinical guidelines, and case studies from practice, a perspective on the current state of the field is provided.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605642","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}

{"title":"[Warning: growing number of young-adults with gonorrhea].","authors":"Patricia Bloem, Bas Mourik, Rosa Joosten, Anna Randag, Maartje Visser, Sacha de Stoppelaar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Since 2022, an steeply increase has been seen in the number of gonorrhea infections in the Netherlands: in 2023 in the sexual heath centra 31% more cases were found, especially among groups where this is less obvious, such as high educated young women. Gonorrhea infections can be seen with the classic symptoms of an urethritis (the drip). But also asymptomatic or in more severe ways and in different locations. In this clinical lesson we provide 3 examples of gonorrhea infections in young women. In neighboring countries, increasing resistance is being observed for ceftriaxone, the first-choice antibiotic to treat gonorrhea. For adequate treatment and to break the infection chain complete microbiological diagnostics or a test of cure can be necessary. The article ends with prevention measures: condom use and effective partner notification.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597253","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}

{"title":"[Optimization of perioperative pain management: a role for a Transitional Pain Service].","authors":"Rianne L M Boekel, Sandra A S Heuvel, Markus W Hollmann, Jörgen Bruhn","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>There is a concern about the increasing use of opioids for non-cancer-related pain. Persistent pain after surgery may contribute to the prevalence of increasing (long-term) opioid use. Identification of patients at increased risk of acute and chronic postsurgical pain and long-term opioid use is suboptimal. This results in a lack of early prevention and optimal treatment of acute and subacute pain in this group. Furthermore, responsibility for postoperative pain after discharge takes places fragmented by both the general practitioner and surgeon. The implementation of a Transitional Pain Service (TPS) appears to be a worthwhile investment to limit the transition from acute to chronic postoperative pain and long-term opioid use after surgery. By using a good risk assessment tool and systematic screening of all surgical patients, the TPS can early identify high-risk patients. These patients can be optimally supported during the perioperative phase with relatively simple personalized interventions.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597252","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}

{"title":"[Medical treatment can become more efficient].","authors":"Peter H J van der Voort","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A substantial part of our expenditure on medical treatment aims to cure the patient from the disease. The effectiveness of these treatments has been proven by Evidence Based Medicine and is assessed by comparing groups of patients. However, not all individual patients benefit from the treatment. In trials this effect is measured by calculating the number needed to treat (NNT). The NNT can be seen as a proxy for the inefficiency of a medical intervention. Usually the NNT is 5 to 50 for both medical and non-medical interventions, which means that a substantial number of patients will not reach the primary endpoint. This is accompanied by adverse effects and costs and is in conflict with our intention to do no further harm. An increase in phase IV post marketing research is needed to reduce the inefficiency of medical treatment. Doctors, government and others should prioritize this type of research.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516248","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}

{"title":"[A woman with anomalies next to an aortic aneurysm].","authors":"Klaas G van der Hem, Sandra P Ferns, Sandra A Srbljin, Robert J L Klaassen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 65-years-old woman developed low-grade fever several weeks after emergency-endovascular-repair of an abdominal aortic aneurysm. 18F-FDG PET/CT imaging showed intensively increased peri-aortic metabolic activity. The inflammation was considered to be either of autoimmune or infectious nature, (un)related to the repair intervention. Analysis showed positive serological and PCR results for <i>Coxiella burnetii</i> pointing to Q-fever periaortitis.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"168 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516249","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}