In this article, the new Dutch pediatric guideline Brief Resolved Unexplained Event is discussed, which replaces the old guideline Apparent Life Threatening Event. The main goal of the new guideline ...is identification of a group of low-risk infants who need not be admitted to the hospital and in which only limited diagnostic workup is indicated. Three fictional cases are presented to highlight the major changes in management of infants who present with an unexplained event. Application of the new guideline will likely result in less clinical admissions and diagnostic testing in these patients.
Unintentional weight loss Kuijpers, Myrthe M; Ten Have, Herma; Harkema, Ukie ...
Nederlands tijdschrift voor geneeskunde,
01/2022, Letnik:
166
Journal Article
In this article we describe the causes and diagnostic work-up of unintentional weight loss. It is defined as loss of weight of at least 5% in 6 months. There is both attention to somatic and ...functional causes of weight loss, as well as iatrogenic causes like side-effects of medication. Referrals to medical specialists for diagnostics are discussed and also the role of dieticians in screening and treatment. Special attention is given to weight loss by malabsorption. Although malignancies as a reason of weight loss is rare in primary care, in secondary care it may be present up to 30%. Treatment of unintentional weight loss may be necessary by high caloric dietary foods when functional decline is obvious, although there is hardly indication for prescribed medication, guidelines for treatment is given.
Best possible start for child and parent van Asbeck, Ellyze V; de Jong-Potjer, Lieke C; van Voorst, Sabine F ...
Nederlands tijdschrift voor geneeskunde,
03/2023, Letnik:
167
Journal Article
The health of women during the periconception period and pregnancy is important for a healthy start of the child. All care providers can make a major contribution to this. In this learning article we ...provide answers to a number of questions that have been collected from the professional field about preconception care and care for vulnerable pregnant women. Our aim is to inform general practitioners and specialists who assist women with a (possible) desire to have children about proactive care in pregnancy, childbirth and child care. Included are concrete actions of the general practitioner when healthy women wish to become pregnant, which medical history and other characteristics of a pregnant woman negatively affects the health of her (unborn) child, and which signals in a first pregnancy predispose for problems after and in a subsequent pregnancy and what role can the GP play in this. Furthermore, we discuss signs of vulnerability in the consulting room, how transmural risk selection can be applied and we provide an overview of interventions applicable in primary care or where to refer to.
Peripheral arterial disease is a common condition in elderly patients. Cases of severe peripheral vascular disease can be treated with endovascular revascularization or bypass surgery. An amputation ...may be necessary if revascularization treatments fail.
A 94-year-old woman with dementia, living in a nursing home, was referred to the vascular surgery team for a painful ulcer on the left foot. Revascularization fails and due to the infectious status, an above-the-knee amputation seems necessary. Family and physicians, however, opt for a conservative, palliative policy and in the next few weeks the infectious ulcer develops into mummification. The patient nonetheless experiences a good quality of life until she becomes bedridden because of pneumonia. She dies 11 months after she was diagnosed with critical limb ischaemia.
Adopting a conservative approach in elderly patients with severe peripheral arterial disease and dementia is a worthwhile alternative to amputation, and can achieve a reasonably good quality of life. Diaries maintained by family members can provide insight into the patient's quality of life.
Age at menopause is under strong genetic control. So far, genetic variations of only one gene, the PvuII polymorphism of the estrogen receptor alpha (ERalpha) gene, have been shown to be associated ...with age at onset of menopause. This study aims to investigate whether PvuII, XbaI and B-variant polymorphisms of the ERalpha gene, and the MspAI polymorphism of the cytochrome P450c17alpha (CYP17) gene are associated with age at menopause in a Dutch cohort.
DNA was isolated from urine samples of 385 Caucasian women with natural menopause and the genotypes of the four polymorphisms were determined. A questionnaire was used for background characteristics. The genotypes of PvuII, XbaI, MspAI were obtained by PCR restriction fragment length polymorphism analysis. The B-variant was determined with an allele-specific oligonucleotide hybridization method. Two-sided t-tests were performed to assess the association between the four polymorphisms and menopausal age. The PvuII and XbaI polymorphisms were analysed separately as well as in a combined score.
The results show that none of the polymorphisms independently, nor the combined genotypes for PvuII and XbaI, were associated with age at natural menopause.
No evidence was found for a relationship between common variants of the ERalpha gene and the CYP17 gene with age at natural menopause.
BACKGROUND: Age at menopause is under strong genetic control. So far, genetic variations of only one gene, the PvuII polymorphism of the estrogen receptor ± (ER±) gene, have been shown to be ...associated with age at onset of menopause. This study aims to investigate whether PvuII, XbaI and B-variant polymorphisms of the ER± gene, and the MspAI polymorphism of the cytochrome P450c17± (CYP17) gene are associated with age at menopause in a Dutch cohort. METHODS: DNA was isolated from urine samples of 385 Caucasian women with natural menopause and the genotypes of the four polymorphisms were determined. A questionnaire was used for background characteristics. The genotypes of PvuII, XbaI, MspAI were obtained by PCR restriction fragment length polymorphism analysis. The B-variant was determined with an allele-specific oligonucleotide hybridization method. Two-sided t-tests were performed to assess the association between the four polymorphisms and menopausal age. The PvuII and XbaI polymorphisms were analysed separately as well as in a combined score. RESULTS: The results show that none of the polymorphisms independently, nor the combined genotypes for PvuII and XbaI, were associated with age at natural menopause. CONCLUSION: No evidence was found for a relationship between common variants of the ER± gene and the CYP17 gene with age at natural menopause.
Summary of the NHG Standard 'Preconception care' van Asselt, Kristel M; de Jong-Potjer, Lieke; Beentjes, Mieke ...
Nederlands tijdschrift voor geneeskunde,
2012, Letnik:
155, Številka:
35
Journal Article
Preconception care is part is the primary care by general practitioners and midwives in the Netherlands. The Dutch College of General Practitioners' (NHG) practice guideline 'Preconception care' ...gives the general practitioner guidelines for assisting couples to be well informed and in the best possible health before conception. The guideline advises general practitioners to be alert for prescription of chronic medication to women wishing to have a child and informs couples wishing to have a child of the availability of a preconception consultation. The general practitioner should review which interventions are necessary in women with chronic disorders. A thorough medical family history is required for the man as well as the woman. Their employment situation and conditions also need to be reviewed. In the case of desire for a child, folic acid is advised. In addition, the practitioner should give advice concerning stopping smoking, healthy weight and avoidance of alcohol use during pregnancy. Implementation of the guideline is especially important for the less educated and for immigrants, as these groups have less healthy lifestyle habits and less knowledge of risk factors in pregnancy.
The Dutch College of General Practitioners (NHG) practice guideline 'Urinary tract infections' intended for primary health care and the Dutch Working Party on Antibiotic Policy (SWAB) practice ...guideline 'Antimicrobial therapy in complicated urinary tract infections' intended for specialists in secondary care, were reviewed together. - In the NHG guideline the differentiation between 'complicated' and 'uncomplicated' urinary tract infections has been replaced by categorisation into age, sex, risk group and the presence of fever, or invasion of tissues.- If urinary tract infection has been diagnosed, a dip slide test can be used to determine resistance.- The guidelines recommend the most narrow-spectrum antibiotic to reduce further increase in antimicrobial resistance.- A chapter about women with recurrent urinary tract infections has been added to the SWAB guideline. Amongst other things, the chapter provides information on the prescription of prophylactic lactobacillus in secondary care.
