Nederlands Tijdschrift Voor Geneeskunde

The introduction of cancer screening programs requires solid evidence of a proper balance between health benefits, harms and resources needed. The primary outcome measure in most randomized cancer screening trails so far has been cancer-related mortality. Collecting data on this outcome requires large study groups and adequate follow-up. Alternative primary outcome measures have been proposed, such as a stage shift, which has been selected in the ongoing UK NHS-Galleri trial. Recent commentaries have discussed the limitations of such alternative outcome measures in cancer screening trials...

This study examines, from a legal standpoint, the conditions under which patient data may be shared and processed by clinical quality registries in the Netherlands and investigates the potential impact of the proposed changes of the Healthcare Quality, Complaints and Disputes Act (WKKGZ) on these practices. Healthcare providers in the Netherlands may share patient data with clinical quality registries to measure and improve care quality, provided they have explicit patient consent or a legal basis. While there is general consensus within the field, legal ambiguity remains regarding processing data without explicit consent...

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.

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...

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...

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...

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...

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...

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%)...

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...

Necrotizing soft tissue infection (NSTI) is a life-threatening illness that can seriously harm a person. Over the last years the incidence of NSTI has increased. A rapid and thorough debridement is crucial to let patients survive. After this debridement, patients will often end up with large skin defects. A burn center is specialized in treating skin defects. Patients with large skin defects after the acute phase of NSTI can be referred to this for a multidisciplinary approach. In this article we describe the surgical treatment of the complex wounds of three referred patients with NSTI in our burn center...

In a 2021 ruling, the central medical disciplinary board changed the requirements regarding the divisions of responsibilities between health care providers by introducing the term 'lead clinician', placing more emphasis on the own professional responsibility of each care provider involved. The lead clinician oversees the continuity and coherence of care, coordinates between caregivers, and serves as a point of contact. Despite concerns about its implementation, national guidelines on responsibility division have adopted the lead clinician concept...

Recent research shows that the functional outcome after an acute Achilles tendon rupture is comparable after conservative versus operative treatment. It is therefore recommended to treat patients conservatively, but strong reasons for surgical treatment exist. In principle, no additional radiographic diagnostic exams are indicated for the diagnosis. An appropriate anamnesis, palpable gap and positive Thompson test have an excellent sensitivity. In case of doubt, an ultrasound should be performed as the first step...

The most controversial issue in the Dutch euthanasia practice concerns the performance of euthanasia in a case of a patient in an advanced state of dementia on the basis of a request that is laid down in an advance directive. This is particularly controversial when such a patient, although lacking decisional capacity on the matter, shows signs of a wish to live. In two important verdicts of April 21 2020 the Dutch Supreme Court has ruled that a request that has been made competently cannot be revoked incompetently...

CRISPR-Cas technology is a revolutionary technology to modify DNA sequences. Owing to its effectiveness and accuracy, CRISPR-Cas holds important promises for 'genetic therapy' for various hereditary disorders. CRISPR-Cas enables researchers to modify specific parts of the genome with unprecedented precision, which, in specific cases, can be applied to correct disease-causing DNA variants. However, several important barriers are complicating the clinical implementation trajectory. There are for example concerns regarding the safety, effectiveness and ethical justification...

This case describes a 58-year-old woman who presented to the dermatology outpatient clinic with progressive skin lesions on the hands. Physical examination showed erythematosquamous plaques. The diagnosis zoonotic dermatomycosis was made based on fungal cultures, which showed a Trichophyton erinacei. This dermatophyte is particularly transmitted through hedgehogs. The patient appeared to have taken care of an infected hedgehog.

OBJECTIVE: Evidence regarding percutaneous vertebroplasty (PV) for chronic painful osteoporotic vertebral compression fractures (OVCFs) remains limited. To compare pain relief, quality of life, and disability between PV and active control (anesthetic infiltration) interventions for chronic OVCF. DESIGN: Randomized controlled trial. METHODS: This prospective randomized clinical trial was conducted between May 2013 and June 2019 in participants with pain due to OVCF lasting longer than 3 months with bone marrow edema present at MRI...

BACKGROUND: Cognitive disorders usually develop slowly over years and are mainly caused by untreatable neurodegenerative disorders. Rapidly progressive cognitive disorders should raise suspicion of an underlying and treatable psychiatric, internal or neurological condition. Timely recognition of these conditions is important. CASE: We present the case of a 68-year old man, presenting on the emergency department with a history of progressive cognitive impairment since several weeks...