Nederlands tijdschrift voor geneeskunde最新文献

There are increasing concerns about the impact of synthetic (plastic) materials on the environment and their potential health risks to humans. The use of plastics in food packaging, clothing, medical products, and car tires can release small plastic particles that enter the human body through air, food, or direct contact. The World Health Organization has evaluated the health risks associated with these so-called microplastics. However, measuring microplastics in the environment and the human body, as well as toxicological research in animal models and cell cultures, remain challenging. Improved methodologies are needed to enhance the quality and specificity of outcomes. Significant knowledge gaps persist, including the role of microplastics in (infectious) diseases. Recent clinical studies have detected microplastics in human tissues such as blood vessels, kidneys, livers, and brains, and have investigated a relationship with diseases like atherosclerosis and dementia. The Netherlands is highly active in microplastics research and is developing a knowledge agenda to mitigate the health risks of microplastics.

Background: The incidence of invasive melanomas increases annually by 3-4%; for melanoma in situ, even by 6-7%. While metastases most commonly occur in the skin, lungs, liver, and brain, abdominal spread, including to the gallbladder, is not uncommon.

Case description: We present a 59-year-old man with a previously treated melanoma on the scalp. He presented with recurrent abdominal pain and a history of melaena. Due to suspicion of cholecystitis, he underwent emergency surgery, which revealed a gallbladder metastasis of the melanoma.

Conclusion: Gastrointestinal metastases of melanoma are frequently asymptomatic and are often diagnosed only upon the occurrence of complications such as obstruction, hemorrhage, or perforation. Nonetheless, metastases to the gallbladder in the context of advanced melanoma are not uncommon. In patients with a prior history of melanoma presenting with new-onset abdominal symptoms or iron deficiency anemia, metastatic involvement of intra-abdominal organs should be considered in the differential diagnosis. Given the often multifocal nature of intra-abdominal melanoma metastases, comprehensive imaging and histopathological evaluation are critical for accurate diagnosis. Management is primarily systemic and requires a multidisciplinary approach; surgical intervention may be indicated in selected cases with symptomatic disease.

In shared decision making (SDM), healthcare providers and patients collaborate towards treatment decisions based on equal input, scientific evidence, and patient preferences. Successful implementation requires clear information, patient support, effective communication, and provider training. SDM increases patient satisfaction and reduces decision regret. Its impact on health outcomes, costs, and consultation time appears neutral to positive. Patients particularly value autonomy, clear information, and opportunities for dialogue. This approach is best suited for preference-sensitive decisions and is more challenging in acute life-threatening situations.

Objective: To assess the knowledge, attitudes and practices of Dutch hearing-healthcare professionals regarding the relationship between hearing loss and cognitive impairment.

Design: Descriptive, quantitative research METHOD: A self-report survey (KAP) has been distributed among Dutch audiological centers and hearing aid dispensers. In total, 100 hearing healthcare professionals completed the survey. Descriptive analyses have been performed for the five domains demographics, knowledge, attitude, practice and training.

Results: There is ample knowledge about the role of cognition within the hearing healthcare and a positive attitude towards the identification of cognitive problems. The knowledge and practices are limited regarding the use of cognitive screening tests. Besides, objective hearing tests are rarely recommended in practice and patients with suspected cognitive impairment are rarely referred to follow-up care.

Conclusion: This study offers clear starting points to make hearing healthcare regarding comorbidity of hearing loss and cognitive problems more future proof. Education, training, referral guidelines, next to self-help programs and brochures for patients can all contribute to this.

Population-based policies, such as sugar taxes, can play a crucial role in preventing lifestyle-related diseases. These policies target the entire population and require limited individual effort to benefit from them. However, assessing the effectiveness of such policies proves challenging due to the long time between exposure and health outcomes, as well as their small effects at the individual level. To identify knowledge gaps regarding effectiveness, a narrative literature review was conducted. This review consistently showed evidence supporting the beneficial effects of subsidies on fruits and vegetables, taxes on unhealthy foods, mass media campaigns, and nutrition and physical education in schools in promoting healthier lifestyles. Since randomized controlled trials for population-based policies are often not feasible, studies should focus more on combining different research methods such as natural experiments, observational studies, and modeling studies.

A 21-year-old woman with no prior medical history presented with upper abdominal pain, fever and pain in the left hemithorax that worsened with breathing. Blood tests showed leukocytosis with atypical lymphocytes, elevated D-dimer, and liver function abnormalities. The CT angiogram revealed splenomegaly with splenic infarctions. This was found to be due to an EBV infection.

Hidradenitis suppurativa (HS) is not an infectious disease; it is a debilitating, chronic autoinflammatory skin condition characterized by inflammation of the hair follicles. It presents in different phenotypes, ranging from recurrent abscesses and nodules to extensive tunnel- and scar formation. HS is associated with smoking, obesity, and various inflammatory and metabolic comorbidities. Both physical and psychological symptoms significantly affect the quality of life of patients. Treatments for this heterogeneous condition include anti-inflammatory medication and/or surgery. The refined Hurley classification, a three-step algorithm, helps determine the severity of HS and guide treatment choices. This article highlights three cases to illustrate the diverse manifestations of HS and emphasizes the importance of a multidisciplinary approach.

Artificial intelligence (AI) is transforming healthcare through its ability to analyse vast amounts of data and recognize subtle patterns. This article explores three key areas where AI shows promise: administrative processes, diagnostic support, and patient monitoring. While AI systems can enhance medical diagnostics it also introduces new challenges. Modern AI models, unlike earlier rule-based systems, use millions of parameters that reduce explainability and complicate already existing accountability questions. Additionally, biases in training data can perpetuate healthcare inequalities. Successful implementation requires hybrid systems where healthcare professionals and AI collaborate effectively, supported by appropriate interfaces and digital literacy. Despite its potential, hardware requirements and integration with legacy systems often slow adoption in clinical settings. The future of healthcare lies not in AI alone, but in the intelligent combination of human expertise and machine capabilities.

Doctors from outside the EEA (IMGs) must successfully complete a Professional Assessment (BI) to be allowed to work as a doctor in the Netherlands. For many this was problematic. Since 2020, there are organizations that help IMGs prepare for this. We analysed the effect of this and compared the BI results and advice at IMGs from 2018-2021 with those from 2022-2024. The BI results were significantly better in 2022-2024 than in 2018-2021. The percentage of advice 'submitted registration' increased from 47.5% in 2018-2021 to 76.9% in 2022-2024. In conclusion, most IMGs are now, unlike before, well prepared to work as a doctor in the Netherlands.

Adults with inherited metabolic disorders (IMD) are a growing patient group. In the Netherlands, adult IMD patient numbers increased fourfold over the past 15 years, from 846 to 3518 individuals, divided over 160 different disorders. The most common disorders are mitochondrial diseases, phenylketonuria and Fabry disease. Approximately half of the patients are diagnosed after age 16. Adult IMD patients require specific care, provided by adult metabolic specialists. Those specialists include, but are not limited to, internists, endocrinologists, neurologists and dieticians. The application of new diagnostic tools, enabling measurement of a large panel of metabolites and assessment of large part of the genome, have greatly improved IMD diagnostics. Better recognition of adults with IMDs, combined with new treatment modalities, will improve quality of life of adults with IMD in the decades to come.