Nederlands tijdschrift voor geneeskunde
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With the introduction of the Youth Act in 2015, the Dutch Ministry of Health has taken a step back from child and adolescent mental health care (CAMHC). This act placed CAMHC under the responsibility of the municipalities, as part of a programme of integrated youth care. Care at municipal level offers unique possibilities for the timely identification of problems and disturbances in adolescence. ⋯ CAMHC needs to be organised at a supraregional level. Since the introduction of the Youth Act there has been a disturbing lack of coherence and a time- and money-devouring new bureaucracy at this level that threatens the survival of CAMHC. The Ministry of Health should step forward to safeguard the efforts of the Association of Netherlands Municipalities and CAMHC professional organisations to maintain and foster supraregional services.
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- Cancer patients often experience pain that has a significantly negative effect on their daily living.- This pain may be caused by the disease process itself, but may also be related to the treatment such as chemotherapy-induced neuropathic pain, chronic pain following surgery and post-amputation pain.- In this training article we will discuss the different aspects of cancer-related pain, based on various questions posed by general practitioners and internists.- Items that are discussed include measurement of pain, opioid therapy, opioid side effects, adjuvant medication, barriers that preclude proper treatment of pain, opioid tolerance and addiction, and interventional therapy.- Pain treatment in cancer patients requires a multidisciplinary team effort, with a central role for the patient.
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In the Netherlands, the application of post-mortem radiology (virtual autopsy) is on the rise. Contrary to conventional autopsy, with post-mortem radiology the body remains intact. There is uncertainty concerning the legal admissibility of post-mortem radiology, since the Dutch Corpse Disposal Act does not contain any specific regulations for this technique. ⋯ This permission can only be obtained after the relatives are fully informed about the proposed activity. In this respect, it is not relevant which technique is used, be it post-mortem radiology or autopsy. Therefore, the other legal conditions for post-mortem radiology are essentially identical to those for autopsy.
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Bacteriophages are viruses that infect bacteria. They are highly specific for a bacterial species. The so-called 'lytic phages' can lyse bacteria when they infect them; these phages can be used to treat bacterial infections. ⋯ Side effects are generally considered to be mild. The selection, preparation and administration of phages for therapy is laborious, and investigations into the clinical benefits are not easy. More research is needed, also in the face of the increasing antimicrobial resistance.
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New epidemics are evolving in modern day society. Obesity, addiction to smoking and a general lack of exercise are threatening the health of the population seen by the general practitioner. ⋯ But can we solve these problems in general practice, during consulting hours? Or have we reached the limits to what we can achieve as general practitioners in reducing addiction to smoking and stimulating weight loss? Of course, we can still help to coach individuals who consult us with one of these problems, but although healthcare in Dutch general practice is of a high standard much more is needed to solve these new epidemics and the problems that threaten the health of the population. Other stakeholders - such as political parties, municipal health services and the government - should also have to bear the responsibility.