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[Dealing with deep uncertainty during a pandemic; make policies adaptive]. [应对大流行期间的高度不确定性；使政策具有适应性]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-01-30
Marcel G M Olde Rikkert, Etiënne Rouwette, Hubert Korzilius, Tom Oreel, Rick Quax, Vincent Marchau, Heiman Wertheim
{"title":"[Dealing with deep uncertainty during a pandemic; make policies adaptive].","authors":"Marcel G M Olde Rikkert, Etiënne Rouwette, Hubert Korzilius, Tom Oreel, Rick Quax, Vincent Marchau, Heiman Wertheim","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This article is a reflection on the covid-19 pandemic and the policy on medical and non-medical e.g. (lock down) measures, and on how we can anticipate earlier on for example effects on education and wellbeing of young people. We show that insights from complexity science are relevant for pandemic policy making and advocate use of resilience indicators, alternative computational models and deep uncertainty modeling. Time series of sick leave can act as resilience indicator in health care and showed large difference between acute care, long term care and mental health care in Dutch covid-19 pandemic. Instead of epidemiology based predict and act models, which mostly turn out to be incorrect, we developed alternative multiscale modelsto simulate interdomain effects. In sum, future pandemics policymaking can profit from adaptive decision making under deep uncertainty.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008639","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
[Residency attrition in orthopaedic surgery; an explanatory model based on qualitative research]. 骨科住院医师磨耗；一个基于定性研究的解释模型[j]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-01-29
Jos J A M van Raaij, Jan Pols, Yvonne Ten Hoeve, A D C Jaarsma, Astrid J de Vries
{"title":"[Residency attrition in orthopaedic surgery; an explanatory model based on qualitative research].","authors":"Jos J A M van Raaij, Jan Pols, Yvonne Ten Hoeve, A D C Jaarsma, Astrid J de Vries","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Many factors can lead to residency attrition. The underlying process however and how these factors interact remains unclear. Understanding this process can provide background to put the available evidence into perspective. The aim of the study was to develop an explaining model that describes voluntary residency attrition.</p><p><strong>Design: </strong>Development of an explanatory model based on qualitative research METHOD: Semi-structured interviews with orthopaedic surgery residents in the Netherlands who dropped out of training, were analysed using the constructivist grounded theory approach.</p><p><strong>Results: </strong>17 interviews were analysed. Reasons for attrition were different for each individual and often a result of a cumulative effect of negative experiences. Individual expectations and needs determine residents' experience with the content of the profession, the professional culture and the learning climate. Personal circumstances and personal characteristics influence expectations and needs. Specific aspects of the residency programme contributing to attrition were type of patient care, required skills, work-life balance and interpersonal interaction (between residents among themselves and between residents and supervisors).</p><p><strong>Conclusion: </strong>This study provides an explaining model of residency attrition that incorporates existing theories and fits well with the results of previous studies.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008646","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
[Neurological side-effects associated with immune checkpoint inhibitors]. [与免疫检查点抑制剂相关的神经系统副作用]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-01-29
Wouter W van Willigen, Dieuwke A Schreurs, Frank M Speetjens, Ellen Kapiteijn, Umesh A Badrising
{"title":"[Neurological side-effects associated with immune checkpoint inhibitors].","authors":"Wouter W van Willigen, Dieuwke A Schreurs, Frank M Speetjens, Ellen Kapiteijn, Umesh A Badrising","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The use of checkpoint inhibitors has shown significant clinical benefit in various cancer types but also carries a risk of immune-related adverse events (irAEs). As the use of checkpoint inhibitors continues to rise, so does the incidence of irAEs. Among these, neurological adverse events (neuro-irAEs) are particularly challenging to detect since they can manifest with a wide range of symptoms, often mimicking disease progression. In addition, neuro-irAEs may follow a severe clinical course, potentially leading to life-threatening consequences if not recognized promptly. We present three cases illustrating the variety in symptoms and signs related to neuro-irAEs including muscle weakness, sensory disturbances, intermittent seizures and double vision. In each scenario, the probable diagnosis of a neuro-irAE posed a significant challenge, necessitating the exclusion of alternative causes. This emphasizes the need for awareness among healthcare professionals regarding neuro-irAEs in the era of expanding checkpoint inhibitor use.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008645","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
['More research is needed' is a meaningless conclusion]. （‘需要更多的研究’是一个毫无意义的结论）。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-01-28
Yvo M Smulders, Jonne J Sikkens
{"title":"['More research is needed' is a meaningless conclusion].","authors":"Yvo M Smulders, Jonne J Sikkens","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This sentence often concludes medical research articles. We argue that 'more research is needed' is an empty phrase. There is always room for synthesis of previously existing and currently added knowledge, allowing for a conclusion on what we now know. Surely, current knowledge is rarely definitive. Sometimes it is, however, in which case valuable resources are better spent elsewhere, rather than in more research on the topic of interest.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008643","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
[Shaking hands or not after the COVID pandemic?] [COVID大流行后握手与否？］
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-01-27
Richard H C Zegers, Rosa van Mansfeld, Rudi D'Hooge, Danny H de Vries
{"title":"[Shaking hands or not after the COVID pandemic?]","authors":"Richard H C Zegers, Rosa van Mansfeld, Rudi D'Hooge, Danny H de Vries","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The tradition of physicians to shake hands with patients is controversial due to the risk of transmitting germs and because of cultural sensitivity. Nevertheless, handshaking is a common way of greeting in Western culture, although some patients prefer not to shake hands for religious or cultural reasons. It is also known that a handshake can transmit pathogenic microorganisms. There are various alternative greetings possible - such as a nod or a bow - that do not carry the potential infection risk of physical contact and also respect patients who do not want to shake hands. There are also many other ways besides handshaking to show respect and engagement towards the patient. Therefore, it is time to seriously reconsider the practice of shaking hands with patients, especially during the season of viral respiratory infections and/or when there are many changing patient contacts, and use alternative greetings when possible and/or desirable.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008647","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
[Should we all do mouth taping? The real story behind breathing through the nose.] 我们都应该用嘴录音吗？用鼻子呼吸背后的真实故事。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-01-23
Digna M A Kamalski
{"title":"[Should we all do mouth taping? The real story behind breathing through the nose.]","authors":"Digna M A Kamalski","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Breathing through the nose has many benefits compared to mouth breathing. There are ways to force breathing through the nose, for instance by mouth taping. It is, however, normal that nasal passage variates. This article describes the normal physiologic variations in nasal breathing. Mouth taping is not needed to change it!</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255849","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 lady who is lying crooked]. [斜躺着的女士]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-01-22
Lise A J Kusters, Linda van de Winkel, Luuk C Otterspoor
{"title":"[A lady who is lying crooked].","authors":"Lise A J Kusters, Linda van de Winkel, Luuk C Otterspoor","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We present a 78-year-old, unvaccinated woman with a tetanus induced severe opisthotonos, requiring mechanical ventilation. We point out the importance of verifying the vaccination status for older patients born before the early 1950's and patients with a migration background. Additionally, we emphasize on administering appropriate post-exposure prophylaxis.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008638","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
[Mucosal disorders of the tongue]. [舌头粘膜紊乱]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-01-21
Najiba Chargi, Munther Al-Rushdy, Thijs Merkx, Marie-Charlotte Huysmans, Stefaan Bergé, Eric Dik
{"title":"[Mucosal disorders of the tongue].","authors":"Najiba Chargi, Munther Al-Rushdy, Thijs Merkx, Marie-Charlotte Huysmans, Stefaan Bergé, Eric Dik","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Mucosal diseases of the tongue, such as lingua geographica and lingua villosa, are relatively common and are usually harmless, but can also be more serious, such as oral cavity carcinoma of the tongue. In this article we discuss the diagnosis and treatment of the most common mucosal diseases of the tongue. The influence of underlying systemic conditions, certain medications and preventive advice are also discussed. We also pay attention to the indications for referral to secondary care.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008644","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
[Hirsutism: a common problem; when to consider rare causes?] 多毛症：常见问题；什么时候考虑罕见原因？］
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-01-20
Myrthe M Kuijpers, Tessa G Steenbruggen, Bart E Pelzer, Joost G Lange, A W A Koot, Iris M M J Wakelkamp
{"title":"[Hirsutism: a common problem; when to consider rare causes?]","authors":"Myrthe M Kuijpers, Tessa G Steenbruggen, Bart E Pelzer, Joost G Lange, A W A Koot, Iris M M J Wakelkamp","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Excessive hair growth is a common and distressing complaint in women. It is imperative to differentiate excessive hair growth from hirsutism with possible other signs of virilization. Hirsutism is commonly attributed to polycystic ovary syndrome (PCOS). Hirsutism with rapid onset or progression, potentially combined with other signs of virilisation or secondary amenorrhea, should prompt evaluation of other underlying causes. In this clinical lesson, we present three cases of hirsutism to illustrate red flags to consider rare diagnoses. Diagnoses include non-classical congenital adrenal hyperplasia, a testosterone-secreting Leydig-cell tumour and PCOS. Early recognition and diagnosis can improve quality of life and, in cases of malignancy, enhance survival outcomes.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008640","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
[Trajectories of health-related quality of life and symptom burden in patients with advanced cancer towards the end of life: longitudinal results from the eQuiPe study]. [晚期癌症患者临终前与健康相关的生活质量和症状负担轨迹：eQuiPe研究的纵向结果]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2025-01-16
Dana van Son, Moyke A J Versluis, Lonneke V van de Poll-Franse, Natasja J H Raijmakers
{"title":"[Trajectories of health-related quality of life and symptom burden in patients with advanced cancer towards the end of life: longitudinal results from the eQuiPe study].","authors":"Dana van Son, Moyke A J Versluis, Lonneke V van de Poll-Franse, Natasja J H Raijmakers","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The number of individuals with advanced cancer is increasing, making palliative care more important. However, there is limited knowledge in the Netherlands about the quality of care received by patients in the palliative phase. This is why the Netherlands comprehensive cancer organization (IKNL) started the 'eQuiPe study' to understand the experienced quality of care and quality of life of patients with advanced cancer and their relatives to further improve palliative care.</p><p><strong>Methods: </strong>Patients with advanced cancer (stage IV) and their relatives were asked to complete questionnaires regarding quality of care and quality of life every three months in 40 Dutch hospitals.</p><p><strong>Results: </strong>The quality of life of patients (n=1108) with advanced cancer declines, particularly in the last three months of life, accompanied by an increase in symptom burden. Quality of life is strongly associated with continuity of care, advance care planning, and open communication about end-of-life situations. Additionally, there is a relation between the well-being of patients and that of their relatives (n=836), which emphasizes the importance of a family-centered approach in palliative care.</p><p><strong>Discussion: </strong>This is the first study to prospectively and longitudinally explore experienced quality of care and quality of life in patients with advanced cancer and their relatives. The key lessons learned from the eQuiPe study indicate that patients and relatives should be regarded as a whole, with attention given to the four dimensions of quality of life (physical, psychological, social and spiritual). Continuity of care must be warranted to provide patients and their relatives with a better support network. Advance care planning is essential in this context.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983752","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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