| 1. |
- Doorakkers, Eva, et al.
(författare)
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Why oesophageal adenocarcinoma is occurring more frequently
- 2015
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Ingår i: Nederlands Tijdschrift voor Geneeskunde. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0028-2162. ; 159, s. A8915-
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Tidskriftsartikel (refereegranskat)abstract
- Article in Dutch. The incidence of oesophageal adenocarcinoma has increased rapidly over the past decades in the Western world. The prognosis is poor with a mean 5-year survival rate of 19% in the Netherlands. Important risk factors that might account for this rising incidence are reflux, obesity and the absence of Helicobacter pylori. Oesophageal adenocarcinoma is 9 times more likely in men than in women. The reason for this much higher incidence of adenocarcinoma in men is still unclear, but sex hormones may play a role. De incidentie van het adenocarcinoom van de slokdarm is snel toegenomen in de westerse wereld in de laatste decennia. De prognose is slecht, met een gemiddelde 5-jaarsoverleving van 19% in Nederland. Belangrijke risicofactoren die verband kunnen houden met de stijgende incidentie zijn reflux, obesitas en de afwezigheid van Helicobacter pylori. Het adenocarcinoom van de slokdarm komt 9 keer zo vaak voor bij mannen als bij vrouwen. Het is nog onduidelijk waarom het adenocarcinoom zo veel meer voorkomt bij mannen. Mogelijk spelen geslachtshormonen hierbij een rol.
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| 2. |
- Dorlo, Thomas P C, et al.
(författare)
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[Concomitant use of proton pump inhibitors and systemic corticosteroids].
- 2013
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Ingår i: Nederlandsch tijdschrift voor geneeskunde. - 0028-2162 .- 1876-8784. ; 157:19, s. A5540-
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To provide an overview of the incidence of peptic ulcer in patients who use systemic corticosteroids and of the underlying mechanism of action, in order to determine whether there is a need for gastric protection using proton pump inhibitors in these patients.DESIGN: Systematic literature review of published meta-analyses and case-control studies, supported by relevant literature on the effects of corticosteroids in relation to the development of ulcers.METHOD: Analysis of literature was performed using the PubMed database with the search terms 'adrenal cortex hormones', 'peptic ulcer' and their synonyms. Meta-analyses and case-control studies with more than 1000 patients were included.RESULTS: The literature search resulted in 970 articles, of which 3 were classified as relevant meta-analyses and 3 as relevant case-control studies. All meta-analyses indicated that peptic ulcer is, at the most, a rare complication of systemic corticosteroid therapy occurring in less than 0.4-1.8% of patients. As the incidence is low, there is no indication for routine prophylaxis with proton pump inhibitors in combination with systemic corticosteroids. There is convincing evidence showing an increased risk of ulcers and a poorer recovery from these when NSAIDs and systemic corticosteroids are used concomitantly; this is a combination for which a proton pump inhibitor should be prescribed.CONCLUSION: Systemic corticosteroid therapy only rarely causes a peptic ulcer. Routine prophylaxis with proton pump inhibitors is therefore not indicated for short-term systemic corticosteroid use.
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| 3. |
- Dorlo, T P C, et al.
(författare)
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[Miltefosine : a new remedy for leishmaniasis].
- 2006
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Ingår i: Nederlandsch tijdschrift voor geneeskunde. - 0028-2162 .- 1876-8784. ; 150:49, s. 2697-701
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Tidskriftsartikel (refereegranskat)abstract
- There is a need for a safe and effective oral treatment for cutaneous and visceral leishmaniasis. Miltefosine is the first oral drug that is efficacious against different forms ofleishmaniasis, however it is not equally effective against all Leishmania species. Miltefosine is an alkylphosphocholine, originally developed for the treatment of cancer. The mechanism of action is probably based on interference with the synthesis and degradation of parasitic membrane lipids. Little is known about the pharmacokinetics ofmiltefosine; an important characteristic is its long elimination half-life of seven days or longer. The most frequent adverse effects are of gastrointestinal origin. Miltefosine should not be used during pregnancy. Over thirty leishmaniasis patients have already been treated with miltefosine in the Netherlands.
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| 4. |
- Jaarsma, Tiny, et al.
(författare)
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[Research set-up concerning the effectiveness of heart failure clinics in the Netherlands]
- 2003
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Ingår i: Nederlandsch tijdschrift voor geneeskunde. - 0028-2162 .- 1876-8784. ; 147:11, s. 513-4
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Tidskriftsartikel (refereegranskat)abstract
- In the Netherlands, the number of patients with heart failure is increasing. Several heart failure management programs have been initiated to reduce the number of readmissions and to improve the quality of care for these patients. However, conclusive data have yet to be provided. In the 'Coordinating study evaluating outcomes of advising and counselling in heart failure', started in 16 Dutch hospitals, 1050 heart failure patients have been randomised into 3 arms: (a) care as usual, (b) care as usual + basic education and support, and (c) care as usual + intensive education and support. Patients will be recruited in 18 months with an 18 month follow-up. This study has three outcomes, namely, time to first major event (heart failure hospitalizations and death), quality of life, and costs.
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| 5. |
- Jaarsma, T, et al.
(författare)
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[Value of basic and intensive management of patients with heart failure; results of a randomised controlled clinical trial]
- 2008
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Ingår i: Nederlandsch tijdschrift voor geneeskunde. - 0028-2162 .- 1876-8784. ; 152:37, s. 2016-21
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine the efficacy of 2 nurse-directed programmes of different intensity for the counselling and follow-up of patients hospitalised for heart failure, compared with standard care by a cardiologist. DESIGN: Multicentre randomised clinical trial (www.trialregister.nl: NCT 98675639). METHOD: A total of 1023 patients were randomized after hospitalisation for heart failure to 1 of 3 treatment strategies: standard care provided by a cardiologist, follow-up care from a cardiologist with basic counselling and support by a nurse specialising in heart failure, or follow-up care from a cardiologist with intensive counselling and support by a nurse specialising in heart failure. Primary end points were the time to rehospitalisation due to heart failure or death and the number of days lost to rehospitalisation or death during the 18-month study period. Data were analysed on an intent-to-treat basis. RESULTS: Mean patient age was 71 years, 38% were women, 50% had mild heart failure and 50% had severe heart failure. During the study, 411 patients (40%) were rehospitalised due to heart failure or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (differences not significant). The time to rehospitalisation or death was similar in the 3 groups: hazard ratios for the basic and intensive support groups versus the control group were 0.96 (95% CI: 0.76-1.21; p = 0.73) and 0.93 (95% CI: 0.73-1.17; p = 0.53), respectively. The number of days lost to rehospitalisation or death was 39,960 in the control group; this number was 15% less in the intervention groups, but the difference was not significant. However, there was a trend toward lower mortality in the intervention groups. In all 3 groups, more visits occurred than planned, which may have had a considerable effect on care, notably in the control group. CONCLUSION: The results of this study indicated that the provision of additional counselling and support by a nurse specialising in heart failure as an adjuvant to intensive follow-up care provided by a cardiologist does not always lead to a reduction in rehospitalisation frequency.
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| 6. |
- Kuenen, Christoffel, 1975-
(författare)
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Transformatie gedreven door Techniek
- 2013
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Ingår i: Nederlands Tijdschrift voor Geneeskunde. - : Vereniging Nederlands Tijdschrift voor Geneeskunde (Netherlands). - 0028-2162. ; :157
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- De bionische mens vertegenwoordigt onze droom van bovenmenselijke krachten.Delen van die droom worden op dit moment al verwezenlijkt door kunstmatige systemen die ons motorische of zintui- gelijke vermogen ondersteunen, vergroten of verrijken.De aansluiting van die systemen op het lichaam verschillen in invasiviteit.De ontwikkeling van prothesen en orthesen wordt gedreven vanuit wetenschap maar met name ook vanuit de mili- taire industrie, en heeft een overwegend technische benadering.
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| 7. |
- Leusink, Peter, et al.
(författare)
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Vragen naar de onbekende weg. De seksuele anamnese in de medische praktijk [Sexual history-taking in medical practice: the elephant in the room?].
- 2016
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Ingår i: Nederlandsch tijdschrift voor geneeskunde. - : Bohn Stafleu van Loghum. - 0028-2162 .- 1876-8784. ; 160:A9896
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Tidskriftsartikel (refereegranskat)abstract
- Recently, the Dutch College of General Practitioners released a Practice Guideline on Sexual Problems which provides clear directives for the diagnosis and management of various sexual disorders in men and women. Patients who are managed in general practice and in outpatient clinics might experience distress related to sexual problems due to their age, medical condition or treatment, or distress related to problems in establishing and maintaining intimate relationships. We present two clinical cases. The first case is a woman aged 44 years with breast cancer treated by mastectomy and adjuvant tamoxifen. The second case is a man aged 54 years with heart failure due to myocardial infarction and resultant loss of physical strength. Both cases illustrate that taking a short sexual history could result in the right treatment and patient satisfaction, without having to go into detail about very intimate and private matters.Case description The first case presents a woman, 44 years of age, with breast cancer treated by mastectomy and adjuvant tamoxifen. During follow up at the oncology clinic, she addressed complaints such as fatigue, mood swings, and sleep problems. The oncologist suspected a depressive disorder and referred the patient to the general practitioner (GP) in order to get support or treatment. The GP diagnosed a mild depressive disorder due to mild problems in her relationship caused by minimal emotional support from her partner. Treatment by a psychologist was advised but because its reimbursement was lacking, the patient decided to refrain. During consultation a year later, the oncology nurse practitioner asked her for her mood problems and asked whether sexual problems might cause her some burden. The patient was relieved to address her problems of decreased sexual desire and dyspareunia. The nurse gave education about the negative but reversible effect of tamoxifen. However, feelings of guilt towards her husband made her persist in having intercourse without satisfaction and therefore the patient was referred to a sexologist, who provided adequate treatment. The second case presents a man, 54 years of age, with heart failure due to a myocardial infarction, leading to loss of physical strength. He is prescribed cardiac medication that might have negative influence on his sexual response, his BMI has been increased, and his alcohol consumption has increased. In addition he had to give up his job and his sports activities. He visited his GP asking for medication to treat his erectile dysfunction. The GP suspected a predominantly somatic cause of his erectile dysfunction and started medication. The result was disappointing, even after increasing the dosage. About a year later, while consulting his cardiologist, the man addressed his sexual problem. After asking only a few questions, it became clear that he still had reasonable erections in some situations. The cardiologist explained that there was apparently still some residual erectile function and advised him to improve his lifestyle in preventing further deterioration of his erectile function. Ultimately this proved to be a good treatment option. Consideration Health care workers can address the importance of sexuality and intimate relationship in the quality of life for the chronically ill, cancer patients, and the elderly, in a basic but effective way. The Dutch Guideline Sexual Complaints provides a basis for diagnosis and management for sexual dysfunctions.
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| 8. |
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| 9. |
- van Veldhuisen, D J, et al.
(författare)
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[The nurse practitioner in the treatment of cardiac patients : successful job reallocation within health care]
- 2006
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Ingår i: Nederlandsch tijdschrift voor geneeskunde. - 0028-2162 .- 1876-8784. ; 150:46, s. 2528-9
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Tidskriftsartikel (refereegranskat)abstract
- There is an ever-growing need for medical staff to provide health care, and several tasks that have traditionally been carried out by physicians are increasingly being undertaken by specialized nurses. Both nurse practitioners and physician's assistants now commonly work in-hospital. In The Netherlands, there have been relatively few studies which have examined the potential role of specialized nurses. A study from Alkmaar shows that the care of patients who have recently had a myocardial infarction, which is normally done by a resident/physician-in-training, can also be carried out by a nurse practitioner, when working within the limits of well-defined protocol, and under the supervision of a staff cardiologist. Although no difference in clinical endpoints was found during the follow-up period, the study shows that patients who were under the care of the nurse practitioner were overall more satisfied with the information that was provided to them, than those under the care of the resident. These findings are important and need confirmation in larger studies and in other patient populations.
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