Nederlands tijdschrift voor geneeskunde
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Non-compliance with medication constitutes a large problem in medicine. Recently the results of a cluster randomised controlled trial were published in which financial incentives were offered to patients with psychotic disorders. ⋯ The financial incentives increased acceptance of depot medication but did not lead to any clinical benefits. Therefore, the implementation of contingency management using financial incentives is not yet desirable.
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In 2008, approximately 1,559,000 Dutch patients consulted their GP because of back pain. One out of 20 back pain patients is ultimately referred to a specialist, most often to a neurologist. ⋯ Scientific evidence in systematic reviews is scarce for the treatments we investigated because of small patient groups and a lack of randomised research. We made an infographic to show the numbers of patients with back pain who visit their GP or a specialist.
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Ned Tijdschr Geneeskd · Jan 2014
Review Case Reports[Acute arthritis in sarcoidosis: Löfgren's syndrome].
Sarcoidosis is a systemic inflammatory disease usually presenting with pulmonary symptoms. However, acute arthritis could be the presenting sign of sarcoidosis. We present a 47-year-old man with bilateral arthritis of the ankles, erythema nodosum and bilateral hilar adenopathy on the chest X-ray. ⋯ Acute arthritis in patients with sarcoidosis with or without the complete Löfgren's syndrome has a good prognosis. Usually the signs and symptoms will disappear within a few months. Unlike other forms of sarcoidosis, Löfgren's syndrome does not require histological proof of non-caseating granulomas.
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All NSAIDs may induce cardiotoxicity. In this respect naproxen is relatively the safest choice. ⋯ After a serious gastrointestinal complication while using NSAIDs, in principal the patient should no longer use NSAIDs. If needed, a coxib plus a PPI is the first choice.
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Ned Tijdschr Geneeskd · Jan 2014
Review Case Reports[Diagnostic evaluation of β-lactam antibiotic allergy].
Many patients report a β-lactam allergy or hypersensitivity without actually having this allergy. Targeted questioning, in combination with an accurate description of the nature of the symptoms, leads to rejection of a large number of these presumed allergies. In a suspected allergic reaction one has to distinguish between the potentially life-threatening, acute type I mediated allergy and delayed type IV skin reaction. ⋯ Patient B was a 58-year-old man with anaphylaxis triggered by amoxicillin/clavulanate as a result of a selective allergy to amoxicillin. Patient C was a 50-year-old man who had had a possible reaction to a penicillin in his childhood. Analysis in an allergology department can be useful for further treatment.