Nederlands tijdschrift voor geneeskunde最新文献

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.

Mucosal diseases of the tongue, such as lingua geographica and lingua villosa, are relatively common and are usually harmless, such as lingua geographica and lingua villosa, 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.

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.

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.

Methods: 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.

Results: 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.

Discussion: 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.

Some older patients with suspected malignancy are not automatically eligible for a standard care process due to frailty or limited treatment wishes. For this group we recommend a personalized approach in which frailty is identified and the patient's wishes are central. To achieve appropriate care, cooperation and timely consultation between primary care or elderly care with a geriatric and/or oncological specialist from secondary care is important. Together, a care plan can be realized, and agreements can be made as to who will have the management role.

Since the corona pandemic, there has been more distrust towards the government and official institutions, more people are attracted to conspiracy theories and society has become more polarized. This increased distrust is also reflected in doctors' consulting rooms. It can be specifically aimed at medical interventions, the prescription of medication and the use of vaccinations, but also more broadly at the doctor as a representative of the established order. This requires doctors to be able to build a good working relationship with a distrustful patient. A conversation technique that has proven effective in promoting collaborative relationships in the event of conflicting beliefs between doctor and patient is the LEAP method. This article provides directions on how doctors can talk and collaborate with distrustful patients.

This case concerns a boy presenting with oral pain and multiple mucocutaneous lesions such as mucositis, conjunctivitis, and a rash on the trunk, extremities, and genitalia. The presence of mild respiratory complaints raised suspicion of an extrapulmonary manifestation of Mycoplasma pneumoniae, known as Mycoplasma pneumoniae-induced Rash and Mucositis (MIRM). The patient underwent conservative treatment and was monitored to prevent chronic sequels such as ocular damage or sicca keratoconjunctivits.

Objective: To evaluate the effect of ferritin-guided donation intervals on haemoglobin (Hb) and ferritin levels, iron deficiency and low Hb deferrals in whole-blood donors.

Design: A cluster-randomized stepped-wedge trial.

Methods: In 2017-2019, Sanquin gradually implemented ferritin-guided donation intervals. Ferritin levels are measured in new donors and at every fifth donation. Donors with ferritin levels ≤ 30 ng/mL are deferred for 6-12 months. Additionally, we assessed donor return within six months.

Results: In the 36 months following the implementation of the policy, the percentage of donors with iron deficiency, low ferritin, and low Hb decreased. Additionally, Hb and ferritin levels increased significantly compared to the previous policy. In males, odds of return decreased significantly after implementation of the new policy.

Conclusion: Ferritin-guided donation intervals effectively improve donors' iron status, but necessitate additional efforts in donor recruitment and retention.

Middle-aged patients with early onset arthritis or cartilage defects are difficult to treat. These patients are relatively young for joint replacement and relatively old for regenerative therapies, i.e.: a treatment gap. Therefore, the concept of joint preservation has emerged with the main goal to delay of even prevent joint replacement. Several novel surgical techniques and treatment algorithms for cartilage repair are developed. New insights show that knee joint preservation is best achieved by combining treatments, for instance cartilage repair and mechanical (alignment) correction. Since combining different surgeries introduces more complexity, a guideline has been drafted, which states that (part of) this care is perhaps best centralised. It is therefore important, to treat patients eligible for joint preservation in collaboration with expert centres. This brief clinical lesson provides the latest insights in the Dutch knee joint preservation care supported by the latest guideline.

Healthcare research into patient volumes and volume-outcome relations can have far-reaching consequences. By means of a thought experiment, five core elements of valid research into patient volumes are identified: variation in numbers of patients, scalability of capacity, comparability regarding quality of care, comparability regarding groups of patients, and statistical precision. Practical challenges are described for each of these aspects as well as their possible impact on research quality. This is illustrated using the example of volume-outcome relations in the field of pediatric cardiac surgery.