Nederlands tijdschrift voor geneeskunde
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Pruritus is the most common dermatological complaint in elderly people and may have a significant negative influence on quality of life. In elderly, the identification of the underlying cause of pruritus can be difficult, due to the broad differential diagnosis and the frequent occurence of comorbidities and polypharmacy. In daily practice, a classification can be used of 'pruritus with primary skin lesions' and 'pruritus without primary skin lesions' for a more specific search to the underlying cause. ⋯ Besides treatment directed at the underlying cause, it is recommended in elderly to always treat xerosis with topical emollients. Topical therapy consists of corticosteroids, anaesthetics and anti-inflammatory agents. Systemic treatments include antihistamines, antidepressants and neuroactive medications.
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A 65-year-old woman, who had been suffering from erosive rheumatoid arthritis, presented with swollen shoulders. Also, she experienced a weary feeling in her left arm. An MRI scan of the left shoulder showed multiple nodules ('rice bodies') in the subacromial-subdeltoid bursa. We extracted the nodules via a deltopectoral approach, after which the symptoms disappeared.
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A doctor with good critical thinking skills will intervene when required, but abstain from intervening wherever possible. He or she has the ability to apply resource stewardship, acknowledges the limitations of guidelines and is able to deviate from protocols when appropriate, with sound arguments for why this is in the patient's best interest. ⋯ This focus should, however, be further emphasized, and should include knowledge of cognitive bias and the skills required for the critical thinking process. On the basis of three patient vignettes several forms of cognitive bias are described, along with bias-mitigation strategies.