Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2019
Review[Application of new glucose lowering drugs: DPP-4 inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors].
A comprehensive review of the literature on DPP-4 inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors has resulted in small changes to the medication roadmap of the type 2 diabetes mellitus standard of the Dutch College of General Practitioners. SGLT-2 inhibitors and GLP-1 receptor agonists may have benefits related to cardiovascular outcomes in patients with high cardiovascular risk, especially in those who have experienced a cardiovascular event. However, ascribing effectiveness related to cardiovascular outcomes on the basis of a single cardiovascular safety trial is premature. Metformin, sulfonylurea derivatives and insulin are still the cornerstone of type 2 diabetes mellitus treatment in primary care.
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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.
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Ned Tijdschr Geneeskd · Nov 2018
[Firework injuries in the south-western region of the Netherlands around the turn of the year 2017-2018].
To report the number of patients with firework-related injuries treated in December 2017 and January 2018 in a hospital in the south-west Netherlands trauma region, and to provide details about the types of firework used and the specific injuries. ⋯ Between 1 December 2017 and 31 January 2018 in the south-west Netherlands trauma region mainly teenage males and bystanders sustained firework-related injuries. Most injuries were upper extremity burns and eye injuries, mainly due to legal fireworks and bangers or decorative fireworks. The extent of the sample indicates that the study findings can be extrapolated to the rest of the Netherlands.