Netherlands Journal of Medicine最新文献

Answer to Photoquiz An impressive chest X-ray…. 一张令人印象深刻的胸部x光片....

4区医学

Netherlands Journal of Medicine Pub Date : 2020-12-01

J Heidt, E M van Keulen, A E C A B Willemsen, J M W van Haarst

引用次数: 0

A fascinating liver abscess. 肝脓肿。

4区医学

Netherlands Journal of Medicine Pub Date : 2020-12-01

C A J van Beers, A-J van Tienhoven, C Stijnis, J Veenstra

引用次数: 0

Implementation of 'Choosing Wisely Netherlands' for internal medicine. 在内科领域实施“明智选择荷兰”。

4区医学

Netherlands Journal of Medicine Pub Date : 2020-12-01

B J Laan, A A van de Woestijne, H A H Kaasjager, S E Geerlings

{"title":"Implementation of 'Choosing Wisely Netherlands' for internal medicine.","authors":"B J Laan, A A van de Woestijne, H A H Kaasjager, S E Geerlings","doi":"","DOIUrl":"","url":null,"abstract":"Background: The Choosing Wisely campaign aims to reduce low-value care to improve quality and lower healthcare costs. Our objective was to determine the current implementation of the Choosing Wisely Netherlands campaign and the 10 recommendations (released in 2014) for internal medicine.Methods: We actively surveyed physicians and residents in the departments of internal medicine in 13 hospitals in the Netherlands. The survey was performed during a presentation about Choosing Wisely and we asked whether they thought that the recommendations were implemented.Results: Between May and November 2018, we surveyed 281 physicians and residents, of which we received 2625 answers (response rate 85%). We found that 178 (68.5%) of 260 physicians were unaware of the Choosing Wisely campaign. For the implementation of recommendations, 1506 (75.2%) of 2003 answers stated that physicians applied the recommendations in clinical practice. We found no differences in implementation of physicians who were aware or unaware of the campaign, respectively 529 (76.1%) of 695 versus 854 (74.2%) of 1151 of the recommendations were implemented; p = 0.357. The recommendation that was implemented least was 'Do not routinely order coagulation tests before invasive procedures', in which 28% stated that they applied this in clinical practice.Conclusion: Four years after the introduction, only one-third of physicians and residents of internal medicine were aware of the Choosing Wisely Netherlands campaign. Nevertheless, most Choosing Wisely recommendations were implemented sufficiently in clinical practice. There is room for improvement, mainly in recommendations that need a multidisciplinary approach.","PeriodicalId":18918,"journal":{"name":"Netherlands Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38765727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Liver stiffness improvement in hepatitis C patients after successful treatment. 丙型肝炎患者治疗成功后肝脏僵硬度改善。

4区医学

Netherlands Journal of Medicine Pub Date : 2020-12-01

S M Brakenhoff, M L Verburgh, S B Willemse, L C Baak, K Brinkman, M van der Valk

{"title":"Liver stiffness improvement in hepatitis C patients after successful treatment.","authors":"S M Brakenhoff, M L Verburgh, S B Willemse, L C Baak, K Brinkman, M van der Valk","doi":"","DOIUrl":"","url":null,"abstract":"Background: Successful treatment of chronic hepatitis C with direct-acting antiviral agents (DAAs) is expected to lead to improvement in liver fibrosis in most of the patients. However, limited data are available on the improvement of advanced liver fibrosis and cirrhosis, measured by transient elastography after treatment. This study assessed the change in liver stiffness measurements after successful treatment with DAAs in patients with pre-treatment advanced fibrosis or cirrhosis.Methods: This observational retrospective cohort study included 514 mono-infected chronic hepatitis C patients, treated with all possible DAA-regimes in the Amsterdam region, the Netherlands. Liver stiffness was measured using FibroScan® at baseline and during follow-up. Cut-off values for staging liver fibrosis were ≥ 9.5 kPa for advanced fibrosis (F3) and ≥ 14.6 kPa for cirrhosis (F4).Results: Liver stiffness decreased significantly from a median of 15.6 kPa (IQR 11.4-25.4) to 9.4 kPa (IQR 6.2-17.0) in 197 patients with pre-treated advanced fibrosis or cirrhosis. In 50.3% of these patients, liver stiffness improved to a value fitting with mild to moderate fibrosis (< 9.5 kPa, F0-F2) after successful treatment. Multivariate analysis demonstrated that a pre-treatment FibroScan® value of ≥ 20.0 kPa was associated with persisting advanced fibrosis or cirrhosis after treatment (OR 29.07, p < 0.001).Conclusion: Liver stiffness improves significantly after successful direct-acting antiviral agent treatment in chronic hepatitis C patients with advanced fibrosis or cirrhosis prior to DAA treatment. Long-term outcomes regarding occurrence of hepatocellular carcinoma (HCC) in these patients are required to determine whether they can be safely discharged from HCC surveillance.","PeriodicalId":18918,"journal":{"name":"Netherlands Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38767259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Doppler follow-up after TIPS placement is not routinely indicated. A 16-years single centre experience. TIPS置入术后不常规进行多普勒随访。16年的单中心经验。

4区医学

Netherlands Journal of Medicine Pub Date : 2020-12-01

K de Wit, O M van Delden, U Beuers, R B Takkenberg

{"title":"Doppler follow-up after TIPS placement is not routinely indicated. A 16-years single centre experience.","authors":"K de Wit, O M van Delden, U Beuers, R B Takkenberg","doi":"","DOIUrl":"","url":null,"abstract":"Background and aims: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention to treat complications of portal hypertension. Since the introduction of polytetrafluoroethylene (PTFE)-covered stents, TIPS patency rates have improved, and the need for routine TIPS surveillance has become questionable. Aims of this study were to assess the indications, clinical outcome and survival, and yield of Doppler ultrasound follow-up in patients who received a TIPS in an academic centre.Methods: A retrospective cohort study of all adult consecutive patients who underwent PTFE-covered TIPS placement between 2001 and 2016. Clinical, biochemical, and imaging findings were reviewed and analysed.Results: A total of 103 patients were included for analysis. At one-year follow-up, control of bleeding was successful in 91% (41/45), and control of refractory ascites in 80% (8/10). In patients with variceal bleeding, a higher MELD score was a risk factor for 90-day mortality (HR 1.28 per point, p < 0.001) and one-year mortality (HR 1.24 per point, p < 0.001). In patients with refractory ascites, a higher MELD score was only a risk factor for 90-day mortality (HR 1.13 per point, p = 0.03). Doppler ultrasound investigations during follow-up revealed abnormalities in 4% (6/166), all of which were associated with clinical deterioration, while abnormalities were detected in 11.4% (19/166) of patients who presented with clinical symptoms of TIPS dysfunction.Conclusion: The use of routine Doppler ultrasound follow-up after PTFE-covered TIPS placement seems unnecessary as it had a very low yield and abnormal Doppler findings were almost always associated with clinical symptoms of TIPS dysfunction.","PeriodicalId":18918,"journal":{"name":"Netherlands Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38765728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An uncommon side effect of thiamazole treatment in Graves' disease. 甲马唑治疗格雷夫斯病的罕见副作用。

4区医学

Netherlands Journal of Medicine Pub Date : 2020-12-01

D van Moorsel, R F Tummers-de Lind van Wijngaarden

引用次数: 0

Hypotonic polyuria: at the cross-roads of copeptin. 低渗性多尿:在copeptin的十字路口。

4区医学

Netherlands Journal of Medicine Pub Date : 2020-12-01

A Gupta, D Zimmerman

引用次数: 0

An impressive chest X-ray…. 令人印象深刻的胸部x光....

4区医学

Netherlands Journal of Medicine Pub Date : 2020-12-01

J Heidt, E M van Keulen, A E C A B Willemsen, J M W van Haarst

引用次数: 0

A diagnostic tool for self-poisoned patients: Analysis of gastric content and lavage fluids. 自我中毒患者的诊断工具:胃内容物和灌洗液分析。

4区医学

Netherlands Journal of Medicine Pub Date : 2020-12-01

L L G Sebek, B C M de Winter, C Bethlehem, G Prins, R Huisman, J Alsma

{"title":"A diagnostic tool for self-poisoned patients: Analysis of gastric content and lavage fluids.","authors":"L L G Sebek, B C M de Winter, C Bethlehem, G Prins, R Huisman, J Alsma","doi":"","DOIUrl":"","url":null,"abstract":"Approximately 500 patients per year are admitted to the emergency department (ED) of the Erasmus University Medical Center presenting with intoxications with medication. For adequate treatment, it is sometimes important to know which drugs in which quantities were ingested. This can require laboratory analysis of blood or urine samples; however, these samples do not provide information about the possible effects that can still be expected. We performed toxicological screening on the gastric content of three patients admitted to our ED in January and February 2018. These patients underwent gastric lavage or received a gastric tube as part of routine care. The gastric fluid was analysed via UPLC-MS/MS using the Waters method for toxicological screening. In all three patients, we successfully determined drugs in the gastric content. In two patients, we identified more different drugs in the gastric content than in blood plasma. In the other patient, admitted approximately six hours after a severe autointoxication with the betablocker metoprolol, we found significant amounts of metoprolol in the gastric content acquired by gastric lavage. We therefore believe that analysis of gastric content after an intoxication can have multiple applications; for example, it may provide information about symptoms of intoxication that can be expected, it may aid patient care and may provide insight in the toxicokinetics of different drugs. In conclusion, we demonstrate that toxicological screening and quantification of drug levels in gastric content is possible and has potential as an adjunct in patient care, but limitations need to be addressed before implementation in clinical practice.","PeriodicalId":18918,"journal":{"name":"Netherlands Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38767188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Answer to Photoquiz A bone disorder with skin lesions. 一种伴有皮肤损伤的骨骼疾病。

4区医学

Netherlands Journal of Medicine Pub Date : 2020-12-01

L Hendrikx, D F G J Wolthuis, R J Hassing

引用次数: 0