Nederlands tijdschrift voor geneeskunde
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In the Netherlands approximately 14,000 patients are referred to hospital for diverticular disease each year. Overall controversy persists about four aspects of treatment of the different stages of diverticulitis, i.e. the role of antibiotics in the treatment of mild diverticulitis, the question of whether elective surgical resection is justified in recurrent diverticulitis or in persisting abdominal symptoms after an episode of diverticulitis, the question of whether patients with purulent peritonitis due to perforation may be treated with laparoscopic peritoneal lavage instead of Hartmann's procedure, and finally, whether resection with a primary anastomosis is a feasible and safe alternative to Hartmann's procedure in the surgical treatment of Hinchey III or IV diverticulitis. These questions will be addressed in four upcoming Dutch randomised trials.
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Ned Tijdschr Geneeskd · Jan 2009
Review[Efficiency of human papillomavirus vaccination--estimates based on Dutch cost effectiveness analyses].
Up to now the turnout for the human papillomavirus (HPV) vaccination programme implemented this year in the Netherlands has been lower than expected. This may be the result of negative publicity and doubts about the efficacy of the vaccination programme. To provide some clarity about the efficacy, this article gives an overview of the cost effectiveness analyses carried out on the introduction of HPV vaccination in the Netherlands. ⋯ It has also been shown that HPV vaccination is a cost effective strategy and that about 1000 girls must be vaccinated to prevent 1 death. The actual health benefits gained by HPV vaccination are strongly dependent on vaccination coverage. It is therefore important that this remains high (85-100%).
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Ned Tijdschr Geneeskd · Jan 2009
Review[Acetylsalicylic acid in patients with diabetes mellitus: can be used for secondary but not primary prevention of cardiovascular events].
There is no consensus in international guidelines about the role of acetylsalicylic acid in primary prevention of cardiovascular events in patients with diabetes mellitus. Primary prevention trials suggest that in diabetic patients, acetylsalicylic acid has either no or less favourable effects in preventing cardiovascular events compared to patients with other cardiovascular risk factors. ⋯ Also increasing the dose of acetylsalicylic acid is probably not worthwhile. We do not recommend acetylsalicylic acid as primary prevention of cardiovascular events in patients with diabetes mellitus, but we do recommend it as a means of secondary prevention.
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Ned Tijdschr Geneeskd · Jan 2009
Review[Perioperative suspension of anticoagulants: practical recommendations].
If patients being treated with anticoagulants need to undergo an operation then physicians need to consider whether to suspend the use of this medication or to allow its use to be continued. Suspending the use of anticoagulants increases the risk of thrombosis, whereas continued use may cause bleeding complications. ⋯ For daily practice, appropriate bridging strategies can be used for perioperative anticoagulant policy for various risk groups, such as patients with venous thromboembolism, atrial fibrillations, mechanical heart valves and coronary heart diseases (including coronary stents) and patients who have experienced a cerebrovascular accident. In the vast majority of cases the treating physician must carefully consider each individual case in order to realise the best policy.