Nederlands tijdschrift voor geneeskunde最新文献

In the Netherlands, approximately 240,000 patients suffer from chronic heart failure, and the incidence is expected to rise in the coming decades. A Left Ventricular Assist Device (LVAD), either temporary or permanent, is increasingly used to treat patients with advanced and end-stage chronic heart failure, with a five-year survival rate exceeding 50%. Healthcare providers in both primary and secondary care will encounter LVAD patients more frequently. Terminal care for LVAD patients requires a specialized approach, with proactive care planning being crucial.

Urinary catheters are often used in primary health care, nursing facilities and in palliative care. Although often effective, the use of these catheters does come with certain risks and complications. In this paper we will answer 10 questions about catheter use in primary health care, with special attention for indications and treatment/prevention of complications.

Objective: The enhanced diagnostic accuracy of ultra-low-dose chest CT (ULDCT) compared to chest X-ray (CXR) at a comparable radiation dose, makes ULDCT an appealing alternative at the emergency department (ED). Design We assessed the impact on health outcomes of replacing CXR with ULDCT in patients with suspected non-traumatic pulmonary disease at the ED. Results ULDCT is non-inferior in short-term functional health with minimal differences in hospital admissions, length of stay, mortality, and economic impact compared to CXR. There were more incidental findings, but less additional imaging procedures after 28 days with ULDCT. Pneumonia was more often correctly diagnosed with ULDCT. In patients with an atypical presentation of pneumonia ULDCT performed better than CXR. Conclusion The results of our trial do not support the unconditional use of ULDCT in the work-up of patients presenting with non-traumatic pulmonary disease at the ED. It is recommended to consider the use of ULDCT instead of CXR in vulnerable patients.

Mallet finger (hammer finger) predominantly results from trauma causing injury to the terminal extensor tendon at the level of the distal phalanx. It remains unclear whether radiography provides additional value in all patients with a mallet finger, which warrants further investigation. We recommend obtaining radiographs in primary care only for mallet fingers resulting from high-energy trauma. The purpose of radiography should not be to distinguish between tendinous and bony mallet fingers, but rather to assess whether surgical intervention may be indicated.

Listening to recorded music can alleviate pain, anxiety, and stress in different healthcare settings. However, it is not standardly offered to patients in clinical practice. This article discusses two patient cases in the Netherlands, providing examples with a focus on practical, social and individual factors. Previous research suggests that there is no universal music suitable for all patients in every situation, but that self-selected and/or preferred music yields the best results for pain management. Looking at individual perceptions, patients face various barriers to listening to (self-selected) music in clinical practice, such as not considering the option and social sensitivity within healthcare contexts. A proactive approach by healthcare professionals and autonomy of patients are essential to overcome these barriers. Practical advice is provided for integrating music into clinical practice, while considering patient perspectives.

A pathologic wrist fracture in a 63-year-old woman was caused by a Brown tumor, which is a rare, benign and focal lytic bone lesion, caused by rapid osteoclastic activity and peritrabecular fibrosis due to primary hyperparathyroidism attributed to a parathyroid adenoma. After removal of the adenoma the Brown tumor decreased.

Chronological age is the most important risk factor for many age-related diseases, but is of limited value in distinguishing the risks of a single individual. In particular, older adults of the same chronological age vary greatly in terms of overall health, presence of diseases, vulnerability, and functional capacity. The underlying (patho)physiological state of the body is a reflection of biological age and may therefore differ from chronological age. However, there is currently no widely accepted definition of biological age. Novel molecular biomarkers are able to capture (part of) the (patho)physiological state of an individual. These biomarkers are becoming increasingly affordable and scalable, but still require validation for their intended application, i.e. reflecting an individual's vulnerability and risk of disease. In this article, we discuss the current state of research into applications of molecular biomarkers and what these developments mean for preventive healthcare and decision-making and treatment of vulnerable older adults.

Background: An estimated hundreds of thousands of patients are treated in the Netherlands every year for an ankle sprain. We describe two cases where the course of an ankle sprain differed from the usual presentation.

Case presentation: Case 1: A 22-year-old male presented to the Emergency Department following an inversion sprain to the ankle. The pain and swelling were localized around the subtalar joint rather than the lateral ankle ligament(s), with limited range of motion in the subtalar joint. Imaging revealed a fracture through a tarsal coalition. The patient was treated with cast immobilization. Case 2: A 50-year-old male presented to the outpatient clinic with ankle pain after a previous ankle sprain. The symptoms involved pain and swelling around the talocrural joint with limited inversion and eversion. Imaging revealed a chronically fractured tarsal coalition. The patient was treated conservatively.

Conclusion: Not every ankle sprain resulting from an inversion injury is a typical lateral ankle sprain. Physicians should maintain clinical awareness for exceptional cases where a fractured tarsal coalition may mimic the symptoms of a lateral ankle sprain.

Medication substantially contributes to global CO₂ emission of healthcare. IV bags and associated materials are an important source of pollution. During the IV bag crisis, caused by the closure of a factory in the US due to Hurricane Helena, emergency measures were implemented to reduce IV bag use. These measures addressed the acute problem and created an opportunity for more sustainable use of IV bags and medication. We discuss four measures to achieve sustainable reduction in usage of IV bags: (1) switching from intravenous to oral medication administration where possible, (2) optimizing intravenous administration through bolus injection or injection port, (3) extending the administration time of unmanipulated IV bags to a maximum of 7 days, and (4) reducing flow rates to 2 ml/h for maintenance of venous access. These measures reduce waste, CO₂ emissions, and costs without compromising patient safety. Environmental sustainability in healthcare requires ongoing awareness and multidisciplinary collaboration.

Tuberculosis is still considered to be a threat to public health in the Netherlands. The Dutch Public Health Act enables the mandatory isolation of contagious patients who are not willing to be treated. However, this act does not mean that patients can be treated against their will. Another act, the Dutch Medical Treatment Act, regulates the contract between doctor and patient. According to this act, only patients who are mentally incompetent can be treated against their will. We describe two patients with contagious tuberculosis who are mentally incompetent. This article explains the steps which, in accordance with both acts, must be followed before starting appropriate treatment.