Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Mar 2008
Review[Practical questions related to self-measurement of blood pressure].
The results of self-measurements of blood pressure predict the risk of developing cardiovascular disease better than those of blood pressure measurements taken at the GP surgery or hospital. In spite of the increasing availability of devices for home measurement, exactly how, by whom, with what and when, blood pressure should be measured at home remains unclear. Self-measurement is to be recommended as a supplement to conventional blood pressure measurement, as, in this way, the white-coat effect and masked hypertension can be recognized. ⋯ A limit for home measurement of 135/85 mmHg should be adhered to. When blood pressure measurements taken at home lead to a different conclusion than those taken at hospital or GP surgery (and if there is no white-coat or masked hypertension), it is recommended that the procedure be repeated. If after this, there is still a discrepancy between the results of these two methods of blood pressure measurement, ambulatory 24-hour blood pressure measurement will perhaps provide the definitive answer to the 'real' level of the patient's blood pressure.
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Ned Tijdschr Geneeskd · Mar 2008
[Increasing pressure on physicians to speak or remain silent; recent legal developments with regard to duty of professional confidentiality and right of non-disclosure].
In principle, the provision of data to third parties, without the patient's consent, is not allowed. There are recent legal developments with regard to the professional confidentiality and right of non-disclosure of the physician. ⋯ Both jurisprudence and two recent bills (Youth Care Act and Social Security Number in Health Care Bill) show that pressure on physicians and institutions to breach the duty of professional confidentiality is increasing. Physicians and their organisations should focus more attention on these problems by education, protocolling and discussion with The Netherlands Health Care Inspectorate and the Public Prosecution Service.
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Ned Tijdschr Geneeskd · Feb 2008
Practice Guideline[Summary of the practice guideline 'Sore throat' (second revision) from the Dutch College of General Practitioners].
The second version of the practice guideline 'Sore throat' has been updated from the 1999 version. --Infections of the throat generally cure spontaneously within 7 days. In most cases the sore throat is caused by a virus. ⋯ This diagnosis can be verified by a test for IgM against Epstein-Barr-virus. --Additional investigations to detect GABHS are not recommended. --Prescribing antibiotics is only recommended for patients who have a severe throat infection or an increased risk of complications. Pheneticillin or phenoxymethylpenicillin remains first choice. --Referral for tonsillectomy should meet the following criteria: 5 or more episodes of sore throat per year or 3 or more episodes per year in the last 2 years.
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Ned Tijdschr Geneeskd · Feb 2008
Comment[The practice guideline 'Sore throat' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].
Compared to the original version and the first revision of the practice guideline 'Sore throat', the second revision by the Dutch College of General Practitioners is clearer and gives practical advice on how to handle. In the Netherlands, most patients who visit their GP due to a sore throat expect antibiotics to be prescribed. Most of these patients will indeed receive a prescription for an antibiotic from their GP. ⋯ Antibiotic treatment is only necessary for severe throat infections. Moreover, most cases of sore throat caused by group A betahaemolytic streptococci will cure spontaneously within one week. It is hoped that this guideline will act as a backup for practicing GPs to enforce critical prescription behaviour.