Nederlands tijdschrift voor geneeskunde
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Studies have shown that the reliability and validity of the Netherlands Triage Standard (NTS) is comparable to the Manchester Triage System. The NTS has good sensitivity and specificity in the emergency room. The Dutch Society of Emergency and Accident Nurses, the Dutch College of General Practitioners and Ambulancezorg Nederland use the NTS as the guideline for both physical and telephone triage in ambulance care, primary care and hospital care with the competence of the triage nurse in a pivotal role.
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Ned Tijdschr Geneeskd · Jan 2015
Case Reports[Spontaneous, atraumatic rupture of the spleen in a young man].
A spontaneous, atraumatic splenic rupture is a splenic rupture without a history of trauma. Rupture of this type may occur in a healthy patient but may also be seen in the context of an underlying neoplastic, haematological, infectious or local inflammatory condition. ⋯ It is clinically difficult to diagnose a spontaneous, atraumatic rupture of the spleen due to the overlap in presentation with other, more common abdominal and thoracic conditions. A CT scan is essential to detect such a rupture promptly in order to provide appropriate surgical intervention.
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Ned Tijdschr Geneeskd · Jan 2015
[Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care].
To compare the effect of pelvic floor muscle training (PFMT) and watchful waiting on pelvic floor symptoms in women aged 55 years and over with symptomatic mild pelvic organ prolapse in primary care. ⋯ Although PFMT led to a significantly greater improvement in PFDI-20 score, the difference between groups was below the presumed level of clinical relevance (15 points). Nevertheless, 57% of the participants in the PFMT group reported an overall improvement of symptoms.
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Childhood melanoma is a rare disorder which is often associated with a diagnostic delay. Worldwide, the incidence of cutaneous melanoma is rising in both adults and children. ⋯ The epidemiology of childhood melanoma in the Netherlands is discussed. In reviewing the literature, we wish to draw attention to important clinical aspects which may contribute to the early recognition of melanoma in children.
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Ned Tijdschr Geneeskd · Jan 2015
Review[Does it still make sense? Deprescribing in the frail elderly].
Elderly patients with multimorbidity often take several chronically used medicines. A large part of this polypharmacy is preventive in intention. Although one would expect that, at the end of life, the ratio of preventive therapy, would decrease in proportion to symptomatic treatment, this appears often not to be the case in practice. ⋯ One of the major reasons for this is uncertainty about the potential clinical consequences of deprescribing. Since frail elderly people seldom participate in clinical drug trials, clear information is not available for this patient group on the balance between the chance of efficacy and the risk of harm of drug therapy. Discussion with the patient about his or her preferences and options with respect to drug therapy is the basis for all subsequent steps and must form part of the periodic reviews of medication.