Nederlands tijdschrift voor geneeskunde最新文献

Incidental pulmonary nodules are very frequently found on CT imaging and may represent (early stage) lung cancers without any signs or symptoms. These incidental findings can be solid lesions or ground glass lesions that may be solitary or multiple. Careful, and systematic evaluation of these findings in imaging is needed to determine the risk of malignancy, based on imaging characteristics, patient factors like smoking habits, prior cancers or family history, and growth rate preferably determined by volume measurements. Once the risk of malignancy is increased, minimal invasive image guided biopsy is warranted, preferably by navigation bronchoscopy. We present two cases to illustrate this clinical workup: one case with a benign solitary pulmonary nodule, and a second case with multiple ground glass opacities, diagnosed as synchronous primary adenocarcinomas of the lung. This is followed by a review of the current status of computer and artificial intelligence aided diagnostic support and clinical workflow optimization.

Dementia is among the most devastating nonmotor features of Parkinson's disease (PD), causing severe decline in quality of life, increased caregiver burden, increased mortality, and often institutionalization. The lack of prominent memory complaints and the increasing physical disabilities due to PD make it difficult for people with Parkinson's disease and their care givers to recognize PD dementia. Education on the profile of cognitive decline to raise awareness in people with PD and caregivers is needed. A timely diagnosis can however result in a better disease management for people with PD and their caregivers, including personalized care, advanced care planning and a reduced risk of unexpected hospitalization. The fear of harming a long term patient-physician relationship can also pose a barrier in the diagnosis and the timing thereof. Interprofessional team-based dementia care can help diagnose and treat people with PD dementia.

Healthcare systems face ongoing challenges of resource and staffing shortages, resulting in complex ethical dilemmas. The Franciscus Hospital approaches scarcity as a moral issue, employing structured moral deliberation to support healthcare professionals in navigating difficult decisions. A hospital ethicist fosters open dialogue, courageous speech, and the documentation of moral case studies (moresprudence), creating a foundation for ethical reflection. Two cases highlight these challenges. In one, a geriatric patient in the Emergency Department revealed tensions between individual care needs and collective safety. In another, limited dialysis capacity during the holidays forced difficult prioritization decisions, underscoring the lack of clear guidelines. Both cases demonstrate the necessity of embedding ethical reflection into organizational culture. By integrating ethics into decision-making, the hospital strengthens trust and supports professionals in making fair, morally sound choices. This approach underscores that ethics is not a luxury but a vital component of responsible, equitable healthcare.

Staphylococcus aureus bacteraemia requires personalized management, as a 'one-size-fits-all' approach is not suitable in this severe infection. Risk-stratification should be used to determine the additional diagnostic work-up needed to define the specific S. aureus diagnosis. To avoid over- and undertreatment, it is of importance to define a specific clinical diagnosis in this often complex and heterogeneous infection.

Background: Return to work (RTW) after hand and wrist surgery is crucial due to the role of hand and wrist function in daily work activities. Despite the importance of RTW, data on this topic following common surgical treatments remain limited and often inconsistent. This study analyzes the median time to RTW after 30 different common elective surgical procedures for hand and wrist conditions.

Method: In this multicenter observational study, routinely collected data from 15,727 employed patients who underwent hand or wrist surgery between 2011 and 2021 in the Netherlands were used. RTW was defined as the time between surgery and resuming original job duties for at least 50% (50%RTW) and 100% (100%RTW) of original working hours. Median time to RTW was calculated using the inverse Kaplan-Meier method, stratified by surgery type and physical job intensity.

Results: Median time to RTW varied significantly across surgical procedures, ranging from 0 to 12 weeks. Patients with light physical work returned 2-3 times faster than those with heavier job demands.

Conclusion: The results highlight the influence of both surgery type and work nature on recovery duration. The overview provided in this article can inform patients about expected recovery timelines and may be relevant for policy-making and economic evaluations of treatment strategies.

A 31 year old woman presented with arthritis of MTP 2 and 3 and painful, swollen and erythematous ears, with sparing of the earlobe. Based on the clinical findings the diagnosis relapsing perichondritis was made.

Laparoscopic cholecystectomy is a commonly performed surgery. Lost gallstones intraoperatively can cause short- and long-term complications. We present a case of a 70-year-old male who presented 15 years after a laparoscopic cholecystectomy. He presented with abdominal sepsis secondary to a perforated large abscess formed around an intraabdominal gallstone. He underwent an acute laparoscopy where 300ml of pus was drained and was admitted to the intensive care unit postoperatively. He was later readmitted with a new abscess with colonic involvement. A percutaneous drainage was performed and later a partial sigmoidectomy was needed. He had a delay of the right diagnosis due to the late presentation postoperatively. Efforts should be made to retrieve spilled gallstones during a laparoscopic cholecystectomy. If this is not possible, it should be documented adequately in surgical notes and discharge letters. Gallstones from a prior cholecystectomy should be kept in the differential diagnosis even years postoperatively.

The use of GLP1-agonists and SGLT2 inhibitors among inpatients increases due to their favorable metabolic, cardiovascular, and renal effects. However, there are concerns regarding their perioperative safety, because of delayed gastric emptying associated with GLP1-agonists which potentially increases aspiration risk, and the risk of (euglycemic) ketoacidosis associated with the use of SGLT2 inhibitors. To avoid these potential complications, it is currently advised to stop GLP1-agonists one dose preoperatively and SGLT2 inhibitors for three days, both of which carries a risk for glucose dysregulation. Since the effect of GLP1-agonists on gastric emptying diminishes with long-term use, we argue that GLP1-agonists can be continued. Also, we argue that SGLT2 inhibitors can be safely continued provided that glucose and insulin are administered perioperatively in patients with type 2 diabetes mellitus, with blood gas measurements among those without type 2 diabetes with an increased risk of ketoacidosis.

Due to climate change, heatwaves are becoming more frequent and intense in the Netherlands, posing disproportionate health risks to vulnerable groups such as older adults, psychiatric patients, and individuals with chronic illnesses. In this opinion article, the authors advocate for a proactive approach to heat adaptation within healthcare. General practitioners and hospital-based specialists can help reduce heat-related stress and mortality through relatively simple interventions, including medication reviews for at-risk patients, early detection of dehydration, and the implementation of personalized heat plans in collaboration with community care providers and pharmacists. Hospital discharge and follow-up policies should also be tailored to extreme weather conditions. The authors call for the structural integration of heat adaptation strategies into both primary and secondary care, using existing risk stratification frameworks. Close collaboration with municipalities and social care networks is essential. The urgency to act is high: preparing for heat should become as routine in springtime as vaccination campaigns are in autumn.

The thorough Cass review into care for adolescents with gender dysphoria concludes that the evidence is insufficient to justify routine treatment with puberty blockers and cross-sex hormones. The review recommends a thorough exploration of the gender problems, and holistic care involving psychosocial interventions to reduce distress and improve global functioning, prioritizing non-medical interventions. Dutch pediatric gender clinics emphasize that such holistic approach is the standard in the Netherlands. However, current Dutch guidelines do not recommend this. Concerningly, the current guideline revision intends to build on the consensus-based and otherwise problematic Standard of Care 8 from the World Professional Association for Transgender Health. This paper argues for evidence-based (interim) guidelines that describe and recommend holistic gender care along the lines of the Cass report. Hormones should be the last resort for minors with gender dysphoria.