Nederlands tijdschrift voor geneeskunde最新文献

Objective: To compare diagnostic accuracy of artificial intelligence (AI) for cervical spine (C-spine) fracture detection on CT with attending radiologists.

Design: Retrospective, diagnostic accuracy study.

Methods: AI analyzed 2368 scans from patients screened for C-spine fracture with CT (2007-2014, fracture prevalence 9.3%). With the use of a validated reference standard, which includes information on injuries in need of stabilizing therapy (IST), diagnostic accuracy of AI and radiologists was calculated and subsequently compared.

Results: Median age was 48 years. AI detected 158/221 fractures and radiologists 195/221, with a sensitivity of respectively 71.5% and 88.2% (p<0.001). Specificity of the AI and the radiologists was comparable: 98.6% and 99.2% (p=0.07). Of the fractures undetected by AI, 30/63 were an IST versus 4/26 for radiologists. AI detected 22/26 scans with fractures undetected by radiologists.

Conclusion: Compared to attending radiologists, AI has a lower sensitivity and misses more ISTs; however, it detected most fractures undetected by the radiologists, including ISTs.

A 39-year old man presented in our emergency room with fever, lymphadenopathy in his right groin and a red papule with a dark center. He was treated with doxycycline and recovered well. Serology showed Rickettsia africae with seroconversion after a few weeks.

Diagnosing rheumatoid arthritis early in patients presenting with pain of hand joints facilitates a fast initiation of effective treatment and, in general, with better results than late initiation of treatment. The diagnosis is based on specific pattern recognition and makes distinguishing with osteoarthritis without laboratory testing or imagine studies possible. These 3 cases of patients presenting with joint pain of the hands show this clinical diagnostic process in detail. Patient history taking in which inflammatory and specific joint distributions guides a first impression toward the diagnosis of rheumatoid arthritis or osteoarthritis. However, the recognition of arthritis is based on detecting synovial swelling of the joint on physical examination. Suspicion of arthritis warrants referral to a rheumatologic center as specific treatment with disease modifying anti-rheumatic drugs are available. Treatment of patients with osteoarthritis can be managed by general practitioners and includes exercises, self-management, splinting and using pain medication.

Follow-up after cancer consists of regular check-ups, aimed at the early detection of recurrences, and aftercare. For most cancers, intensive follow-up strategies are recommended. However, for several cancer types, including breast and colorectal cancer, reducing the follow-up frequency has had no detrimental effects on outcomes such as survival (hazard ratio (HR) 1.05; 95%-BI: 0.96-1.14) and patient satisfaction. In cancers with a favorable prognosis, less intensive follow-up is likely to be equally effective, and can be personalized to individual needs. To do so, current follow-up guidelines must be critically reevaluated, and the benefits of performing regular check-ups should be investigated.

This clinical lesson addresses the treatment options for polydactyly, emphasizing the lack of consensus in the Netherlands regarding the timing and method of intervention. The study aims to provide evidence-based recommendations for the management of post-axial polydactyly type B. Two cases are presented, each illustrating different approaches to surgical intervention for post-axial polydactyly type B in a 1-year-old boy (Patient A) and a newborn girl (Patient B). Patient A undergoes surgical removal of an extra digit under general anesthesia after waiting for a year, while Patient B undergoes prompt surgical removal under local anesthesia. Both procedures are successful with no complications, demonstrating positive outcomes for early surgical intervention under local anesthesia. The study advocates for revising outdated national guidelines, recommending surgical removal under local anesthesia within the first three months after birth for post-axial polydactyly type B. Delaying intervention increases stress, risks, and costs without apparent benefits. This clinical lesson calls for optimizing care for children with post-axial polydactyly type B through guideline updates.

During multidisciplinary team meetings, treatment plans are discussed for patients with colorectal cancer. Guidelines and protocols guide these decisions, but these are also dependent on the perception of the treatment outcomes by the involved specialists. With the increasing treatment options for increasingly older patients with more comorbidities, predicting outcomes for specific subgroups becomes more challenging. In a survey pertaining to treatment outcomes, we found that surgeons' estimations are not very accurate, especially not for specific risk groups. The limited accuracy of predicted outcomes affects decisions during the multidisciplinary team meetings and during the shared decision-making process in the outpatient clinic. Utilizing existing data-driven as well as innovative AI-enhanced methods to predict outcomes, can help to better inform patients and make both the multidisciplinary team meetings and the shared decision-making more precise.

Coughing may impair the quality of life, for instance by interfering with sleep or social interactions. Acute cough is almost invariably caused by a viral respiratory tract infection and seldom warrants medical consultation or treatment. Red flags in cough (haemoptysis, high fever or severe illness) may be indicative of a life threatening underlying disease. Wet and dry cough often have the same aetiology, and a different approach is therefore not needed.

A 24-year-old male patient was seen with generalized itch and papules located at the hands. Staining of a papule with a purple medical skin marker, followed by wiping of the ink with an alcohol-gauze revealed an ink-filled burrow. These findings are consistent with a positive burrow ink test, and a clinical diagnosis of scabies was made.

Objective: To investigate whether referrals of general practitioners (GPs) to the memory clinic align with the regional and national dementia guidelines.

Design: For this single center retrospective study, data was collected from electronic patient files.

Method: GP referrals to the memory clinic over a 1-year period were categorized and evaluated according to the regional and national guidelines.

Results: 310 GP referrals were included with the most common referral motivations: "Additional somatic or psychiatric factors" (77; 24,8%) and "Straightforward dementia diagnosis" (70; 22,6%). A total of 51,0% of referrals were not in line with regional guidelines: either because of non-compliant referral reasons; or limited cognitive assessment without clinical findings and/or cognitive testing.

Conclusion: Half of GP referrals to the memory clinic were not in line with the national and regional guidelines. Referrals were often not preceded by clinical findings and/or cognitive testing. Aiming for effective care, cognitive assessments in primary care should be encouraged and with appropriate assistance.

Objective: To gain insight into the blood culture (BC) utilization in emergency departments (EDs) and to identify differences in the indications for BC collection.

Design: Retrospective study METHOD: Data were collected in 11 EDs for 2018, 2019, and 2020. Indications for blood culture collection were identified in from the hospital protocols. Participants indicated which indications are used in their ED.

Results: In 2019, ten EDs collected BC from 19% to 30% of all patients for internal medicine and geriatrics. Both the used indications and the cutoff values varied. For fever, >38.0°C, >38.3°C, or >38.5°C were used, and for hypothermia <36.0°C or <35.0°C.

Conclusion: There is a variation in the percentage of collected BC in the EDs. Additionally, the used indications and the cutoff values differed. A national discussion on criteria is needed to reduce this variation. Meanwhile, structured benchmarking can make BC collection more appropriate.