Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2015
Review['Which breast implant do I have?'; the importance of the Dutch Breast Implant Registry].
About 1 in 300 women in the Netherlands has a breast implant but many patients do not know what type of implant was inserted. The quality of breast implants is currently monitored by the implant manufacturers. ⋯ Good national and international collaboration with the government, the manufacturers and other specialist associations is crucial for setting up an implant registry. Since April 2015, data about patients and their implants have been collected, independently and prospectively, in the Dutch Breast Implant Registry to increase patient safety in cases of breast implant surgery in the Netherlands.
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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
[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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Ned Tijdschr Geneeskd · Jan 2015
[Psychotropic drug prescription to people with intellectual disability in GP practices].
Antipsychotic drugs are more often prescribed in primary care to people with intellectual disability (ID) with challenging behaviour, sometimes even without a diagnosis, than to those with a diagnosed mental illness. This is shown in a large cohort study in the United Kingdom in primary care and in a Dutch study in three residential care facilities. This prescription behaviour is undesirable. ⋯ The Dutch study showed that antipsychotic drug reduction in people with ID with challenging behaviour led to improved behaviour and improvement of physical parameters. A skilled multidisciplinary team of professionals can help with alternative management strategies for challenging behaviour. These teams should be made available for primary care services.
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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.