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[Insulin intoxications caused by falsified semaglutide]. [假西马鲁肽致胰岛素中毒]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-29
Julian Stammers, Davine Hofste Op Bruinink, Peter G A Karel, Casper J van der Hoeven, Suzanne Schol-Gelok, Manon C Stam-Slob
{"title":"[Insulin intoxications caused by falsified semaglutide].","authors":"Julian Stammers, Davine Hofste Op Bruinink, Peter G A Karel, Casper J van der Hoeven, Suzanne Schol-Gelok, Manon C Stam-Slob","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Treatment with glucagon-like peptide-1 receptor agonists such as semaglutide is generally subject to strict reimbursement criteria. This leads to a growing off-label market outside of the regular healthcare system without strict quality controls, which may jeopardize patient safety.</p><p><strong>Clinical context: </strong>Two cases are reported of patients without diabetes or obesity, who had injected semaglutide subcutaneously that was obtained without a prescription. Both presented in a coma with severe hypoglycemia, hypokalemia and hypothermia, which was caused by an intoxication with synthetic insulin. Monotherapy with semaglutide is not associated with significant hypoglycemia in healthy individuals. Up to two days of continuous glucose infusion was required to keep patients euglykemic.</p><p><strong>Conclusion: </strong>The use of illegally obtained semaglutide may lead to life-threatening intoxications, due to insufficient safety precautions for the provided medication. Timely notification of cases to the national health regulatory authority is essential to mitigate further distribution of falsified drugs.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369322","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
[Professional skepticism in medical research]. [医学研究中的专业怀疑主义]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-29
Patrick M Bossuyt
{"title":"[Professional skepticism in medical research].","authors":"Patrick M Bossuyt","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Some researchers in clinical medicine are firmly convinced about the benefits and the superiority of the treatments that they are evaluating. This may lead to conscious or unconscious decisions that affect the design, conduct, analysis, and reporting of trials. While human, and understandable, this practice should be balanced. This can be done by assigning professional skeptics in multidisciplinary research teams, aiming for adversarial collaboration in science, as advocated by Kahneman, and by installing Red Teams in complex analyses. Passion is what drives many, if not most, scientists. In clinical trials, the enthusiast should be surrounded by like-minded spirits, who can assemble the energy to finish the project. Yet there should also be at least one professional skeptic in the team.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369294","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
[Improving mobility in painful osteoarthritis]. [改善疼痛性骨关节炎的活动能力]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-25
Gezina T M L Oei, Rienk van Beek, Selina van der Wal, Monique Steegers, Jan Willem Kallewaard, Rudolf W Poolman
{"title":"[Improving mobility in painful osteoarthritis].","authors":"Gezina T M L Oei, Rienk van Beek, Selina van der Wal, Monique Steegers, Jan Willem Kallewaard, Rudolf W Poolman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The incidence of osteoarthritis of the knee, hip, and shoulder is rising in the Netherlands due to aging and leads to a high disease burden. In addition to rising healthcare costs, reduced work participation and limitations in independent living in this patient group are problematic. The treatment algorithm for osteoarthritis starts with conservative treatment, including analgesics. If the effect is insufficient, a joint replacement surgery follows. Some patients are not operated on due to age and/or comorbidity or disease stage. Sometimes there is a long waiting time or the surgery does not yield the desired result. When analgesics also do not work in these cases, pose too much risk, or cause side effects, these patients continue to experience pain and a reduced quality of life. A peri-articular denervation treatment can reduce pain in osteoarthritis and get the patient moving again. The treatment algorithm for pain in osteoarthritis needs to be further developed in the coming years.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308750","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 effectiveness and costs of the Back At work After Surgery (BAAS) work-integrated care pathway on return to work for patients receiving knee arthroplasty]. [术后重返工作（BAAS）工作-综合护理路径对膝关节置换术患者重返工作的有效性和成本]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-25
Daniël O Strijbos, Geert van der Sluis, Tim Boymans, Michiel F Reneman, P Paul F M Kuijer
{"title":"[The effectiveness and costs of the Back At work After Surgery (BAAS) work-integrated care pathway on return to work for patients receiving knee arthroplasty].","authors":"Daniël O Strijbos, Geert van der Sluis, Tim Boymans, Michiel F Reneman, P Paul F M Kuijer","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness and costs of the Back At work After Surgery (BAAS) integrated care pathway for workers receiving knee arthroplasty in the Netherlands.</p><p><strong>Design: </strong>Comparative cohort study of the BAAS cohort versus two usual-care cohorts.</p><p><strong>Methods: </strong>BAAS included explicit discussion of RTW in orthopedic consultations, workplace assessment, Goal Attainment Scaling, activity monitoring and an interdisciplinary online consult at 4-5 weeks postoperatively. Cohorts shared similar inclusion criteria and return-to-work and cost outcomes. Time to (full) RTW was analyzed with IPTW/Cox regression and costs with propensity score matching.</p><p><strong>Results: </strong>Median time to first RTW was 27 days in BAAS versus 52 and 43 days in controls (HR 2.7 and 1.95). Full RTW took 183 versus 210 days (HR 1.4). Non-RTW within 12 months was 2% versus 16% and 13%. Intervention cost €845 with cost reductions of €4,493 per worker from employer perspective.</p><p><strong>Conclusion: </strong>BAAS accelerates return-to-work and delivers substantial economic benefits.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308818","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 a wound on his elbow]. [肘部受伤的男子]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-24
Kim A E Thissen-Steenvoorden, Caroline Becker, Duco D Deenstra
{"title":"[A man with a wound on his elbow].","authors":"Kim A E Thissen-Steenvoorden, Caroline Becker, Duco D Deenstra","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 27-year-old Indonesian man, presented to the ED with a non-healing wound on his left elbow and unintentional weight loss of 6 kg. Further investigation revealed the unexpected cause: An inadequate treated disseminated tuberculosis. This case highlights the importance of considering extrapulmonary TB in persistent soft tissue infections.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308740","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
[Osteoarthritis of the ankle: to offload, fuse or replace?] 踝关节骨关节炎：要卸载、融合还是替换？］
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-22
Robbin W Klaassen, Astrid J de Vries, J H Anne Veldhuijzen, Tom M van Raaij
{"title":"[Osteoarthritis of the ankle: to offload, fuse or replace?]","authors":"Robbin W Klaassen, Astrid J de Vries, J H Anne Veldhuijzen, Tom M van Raaij","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Symptomatic ankle osteoarthritis is associated with a substantial disease burden. Although many patients benefit from nonsurgical management, surgical intervention is commonly indicated for endstage osteoarthritis. In recent years, total ankle arthroplasty (TAA) has gained popularity. Patient A: 90 y/o female, severe comorbidities, idiopathic ankle osteoarthritis, orthopedic shoe adaptation. Patient B: 58 y/o female, healthy, arthrodesis for osteoarthritis due to chronic instability, pain-free after one year, full consolidation. Patient C: 66 y/o male, healthy, TAA for posttraumatic osteoarthritis, pain-free one year after surgery with good ankle mobility. The choice of treatment is guided by patient-specific characteristics. Nonoperative management is generally preferred for individuals with mild symptoms, minimal osteoarthritic changes, or those who are non-operable. Arthrodesis is typically indicated for younger, physically active, or heavier patients, whereas total ankle arthroplasty (TAA) is more suitable for relatively older, moderately active patients with a flexible, neutrally-aligned ankle. Overall, management of ankle osteoarthritis is individualized, and TAA can be an effective option for appropriately selected patients.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295583","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 power of a neurodiversity perspective; demedicalizing mental health support]. [神经多样性视角的力量；将精神健康支持去医疗化]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-18
Jim J van Os, Femke F Veldman
{"title":"[The power of a neurodiversity perspective; demedicalizing mental health support].","authors":"Jim J van Os, Femke F Veldman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This article explores how thinking in terms of neurodiversity can help clinicians take mental distress seriously without unnecessarily medicalizing normal variation. Rather than searching for a disorder label, the focus shifts to a profile of sensitivities and talents, always understood in relation to context. The article shows where the categorical DSM model falls short in everyday clinical practice, particularly due to comorbidity, heterogeneity, and a tendency to overlook strengths. As an alternative, a simple dimensional framework with seven developmental dimensions is presented. This framework provides clinicians with a practical language to work with patients, parents, schools, or employers in understanding where a person struggles and where they thrive. Two clinical vignettes illustrate how this approach can lead to more concrete contextual adaptations, less pressure to label, and a more cautious and goal-oriented use of medication. The core message is that neurodivergence is best understood as a dynamic state of dysregulation in a specific context rather than as a fixed identity trait.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295648","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
[Employment of safety net enclosures]. [使用安全网围栏]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-17
Charlotte S A Schrama, Katinka Hummelen, Rob M Kok
{"title":"[Employment of safety net enclosures].","authors":"Charlotte S A Schrama, Katinka Hummelen, Rob M Kok","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>When medication and other interventions for challenging behaviour in people with dementia are insufficient, safety net enclosures are frequently used. It is a restrictive intervention with a limited number of available research studies. This article presents some data from an observational study that we have published recently. Finally, we discuss for which patient groups, in which settings, and under what conditions the use of safety net enclosures could be considered.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295440","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
[Human granulocytic anaplasmosis: an autochthonous tick-borne disease with a potentially severe course]. [人粒细胞无形体病：一种具有潜在严重病程的本地蜱传疾病]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-16
Janine J G Arts, Arjen J Cupido, Dieuwertje Hoornstra, Hein Sprong, Jacob C Dutilh, Daan W Notermans, Susanne P Stoof, Joppe W Hovius
{"title":"[Human granulocytic anaplasmosis: an autochthonous tick-borne disease with a potentially severe course].","authors":"Janine J G Arts, Arjen J Cupido, Dieuwertje Hoornstra, Hein Sprong, Jacob C Dutilh, Daan W Notermans, Susanne P Stoof, Joppe W Hovius","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Human granulocytic anaplasmosis (HGA) is caused by Anaplasma phagocytophilum. In the Netherlands, the bacterium is present in a few percent of Ixodes ricinus ticks, but only a specific subvariant is associated with human disease. Although the infection is often asymptomatic, the clinical course can be severe and unpredictable. Here, we describe three recent Dutch cases: two autochthonous cases with a severe course and one case acquired in the United States. All patients recovered rapidly after initiation of doxycycline following the final diagnosis. Awareness of tick-borne diseases other than Lyme disease is important for healthcare professionals in primary, secondary, and tertiary care, as well as for supporting (laboratory) specialties such as clinical chemistry and medical microbiology.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295394","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 value of experts-by-experience support in outpatient care]. [专家经验支持在门诊护理中的价值]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-11
Vincent J T Peters, A M Lisa de Hoog, Helma B M van Gameren-Oosterom, J Peter de Winter, Tineke Eulderink, Levinus A Bok
{"title":"[The value of experts-by-experience support in outpatient care].","authors":"Vincent J T Peters, A M Lisa de Hoog, Helma B M van Gameren-Oosterom, J Peter de Winter, Tineke Eulderink, Levinus A Bok","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To explore the experiences of experts-by-experience (parents of a child with Down syndrome) involved in outpatient care;of healthcare professionals collaborating with them; and of parents of children with Down syndrome receiving outpatient care.</p><p><strong>Design: </strong>Semi-structured interviews and observations.</p><p><strong>Method: </strong>Data were collected through four interviews with experts-by-experience, seven with healthcare professionals, and seven with parents of children with Down syndrome, all connected to the downteam. Observations were conducted during downteam visits. Interview transcripts were thematically analyzed.</p><p><strong>Results: </strong>Experts-by-experience act as a bridge between healthcare professionals and parents, improving the quality of care and quality of life for children and families. Their support extended beyond medical care to social-emotional and practical aspects of daily living.</p><p><strong>Conclusion: </strong>Experts-by-experience make a unique contribution to outpatient care. Their lived experience makes them valuable partners in improving both the quality of care and life for children with Down syndrome and their families.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252506","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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