Nederlands tijdschrift voor geneeskunde最新文献

An increased fracture risk is a common chronic condition leading to a rising number of fractures, which are injurious to patients and costly to the health care system. Effective diagnostic and treatment options are available for fracture prevention. In this article, we will answer specific practical questions with respect to increased fracture risk and fracture prevention. Topics discussed include definitions, risk factors, the diagnostic modalities and treatment options.

Objective: To gain insight into the considerations that citizens find important for the societal acceptability of prices and expenditures on expensive medicines.

Design: Citizens' forum and representative survey.

Method: A forum of 24 citizens formulated key reimbursement considerations following case discussions. Subsequently, an online survey (n=884) assessed how broadly these considerations were supported.

Results: Citizens are more willing to accept higher prices for severe conditions, complete recovery from illness, or when medicines contribute to improved quality of life, or societal participation. At the same time, they draw clear boundaries: uncertainty about effectiveness, limited innovation, or excessively high prices undermine acceptability. Policymakers should explicitly consider these preferences in managing reimbursement decisions. Citizens believe the government must have the courage to say 'no' to excessively expensive medicines and urge manufacturers to be transparent and socially accountable regarding their pricing practices.

Conclusion: Citizens consider a wide range of factors, accepting higher prices only when benefits are evident. Their preferences align with existing criteria used by public agencies, yet highlight the need for refinement, particularly regarding transparency, pricing, and market behaviour. Structural citizen participation can further strengthen public support for difficult choices in health care.

Cancer patients experience income loss and extra expenses which can contribute to ongoing difficulties regarding their financial situation. This objective financial burden has significant implications for the psychological and physical well-being of survivors, yet there is a lack of guidance and support to navigate financial challenges. By recognizing financial toxicity and taking proactive measures, healthcare professionals should better assist cancer survivors in navigating financial challenges they may encounter at the long-term.

We present the case of a 59-year-old male with multiple papules covering his arms and legs. A biopsy was suggestive for eruptive xanthomas. Additional biochemistry showed a triglyceride count of 900 mg/dL and a hemoglobin A1c of 11,4%. The diagnosis of diabetes mellitus was made, without other symptoms of weight loss, polydipsia or polyuria.

Anxiety frequently leads to prematurely discontinued MRI- or CT-examinations, with negative consequences for patient experience, workflow, treatment and cost. To reduce this anxiety to manageable proportions, psychological interventions appear to be more effective than mere information provision or technological improvements. Two case studies illustrate the impact of different approaches in anxiety reduction, supporting the results of a retrospective study of 68 patients. Here, 74% of patients successfully completed an MRI or CT scan after personalized eclectic treatment. For most patients, one or two treatment sessions were sufficient.

In acute bronchospasm due to asthma/COPD exacerbations two bronchodilators are frequently used: ipratropium, an acetylcholine antagonist, and salbutamol, a β2-agonist. The combination ipratropium/salbutamol gives more bronchodilation than ipratropium monotherapy in asthma/COPD exacerbations, but there are concerns about cardiac safety of salbutamol. Salbutamol in regular dosage does not affect heart rate in diverse populations (ED, ICU and children). Only a dosage 5-10x the standard dosage of 2,5 mg leads to a 20-30-beat increase in heart rate. High-dose salbutamol induced a mild increase of QTc interval (±360 to ±390ms) and QTc dispersion (maximum minus minimum QTc; marker for susceptibility to arrhythmia), but not to a clinically relevant extent. Most importantly, literature shows that the incidence of arrhythmia is similar between salbutamol and placebo. Salbutamol did not induce severe arrhythmias, including in arrhythmogenic ICU populations or in patients with severe COPD with cardiac comorbidity. We therefore argue that the current caution exercised with the use ipratropium/salbutamol is unjustified. Treatment should not be withheld in case of tachycardia or underlying heart disease.

Myxedema psychosis, also known as myxedema madness, is a rare neuropsychiatric manifestation of untreated or inadequately treated hypothyroidism. We report the case of a 46-year-old woman presenting to the emergency department with acute psychiatric symptoms, including confusion, hallucinations, and delusions. Physical examination revealed classic signs of hypothyroidism, such as periorbital edema, dry skin, and diffuse hair loss. Laboratory results showed a markedly elevated thyroid-stimulating hormone (TSH) level of 45.76 mU/L and a severely reduced free thyroxine (T4) level (< 1.0 pmol/L), confirming the diagnosis of myxedema psychosis. Intravenous administration of levothyroxine and liothyronine (T3) led to rapid resolution of psychotic symptoms. This case report underscores the critical need to evaluate somatic causes, including hypothyroidism in patients presenting with acute psychiatric symptoms. Timely diagnosis and appropriate thyroid hormone replacement therapy can result in full recovery.

A 51-year old male with an altered consciousness was presented to the hospital after ingestion of unknown quantities of medication, alcohol and turpentine. During examination, erythematous buttocks were noticed and first degree decubitus was suspected. The following day second degree burns on his buttocks and thighs were noticed.

Objective: This study quantifies and characterizes unused medical disposables in operating rooms to determine their carbon footprint and identify opportunities for sustainable improvements in healthcare.

Design: Observational study.

Method: The study was conducted at Amsterdam University Medical Centre, a tertiary hospital with 44 operating rooms. Unused disposables from surgeries conducted during office hours were collected for two weeks. The number, weight and volume of the disposables were determined for each surgery. The carbon footprint was calculated based on data from a Life Cycle Assessment.

Results: 1785 unused disposables were identified from 187 surgeries, with a carbon footprint of 338 kg CO2-equivalents (kg CO2-eq) and weighing 60 kg. Gauze (37 kg CO2-eq) and surgical drapes (127 kg CO2-eq) were found to have the largest carbon footprints, with gauze contributing substantially due to their frequent waste (n = 527; weight = 3 kg) and drapes due to their weight (n = 154; weight = 15 kg).

Conclusion: Unused disposables in operating rooms cause waste and a substantial carbon footprint.

Large language models, AI-based models that can generate language and which are optimized for human interaction, are widely available and also offer opportunities for healthcare. Yet, they also raise important questions about their quality and ethical-legal issues. This article answers ten questions about the use of large language models in healthcare.