[A critical view on cancer screening: do we see the elephant in the room?].

Cancer screening promises health benefits but it also delivers harms and costs. A substantial problem is overdiagnosis of tumors not needing treatment. There are well established principles for starting cancer screening, but we also need periodical evaluations and stopping rules.

Predictors for neoplastic progression in patients with Barrett's Esophagus: a prospective cohort study.

Objectives: Patients with Barrett's esophagus (BE) have an increased risk of developing esophageal adenocarcinoma (EAC). As the absolute risk remains low, there is a need for predictors of neoplastic progression to tailor more individualized surveillance programs. The aim of this study was to identify such predictors of progression to high-grade dysplasia (HGD) and EAC in patients with BE after 4 years of surveillance and to develop a prediction model based on these factors.

[Sterile gloves are not necessary in minor surgery].

According to the practice guideline of the Dutch Workingparty on Infection Prevention (WIP) sterile gloves have to be worn during minor surgery by the general practitioner. This is based on the microbiological principles of Spaulding and is not supported by other evidence. Current literature suggests that using clean, nonsterile gloves, instead of sterile gloves, does not result in a greater risk of wound infection in primary closed wounds after minor surgery.

[Diagnosis of breast cancer missed in a young woman].

The diagnosis of breast cancer in a 31-year-old woman was delayed, apparently because she did not comply with advice to come for a follow-up appointment after an initial diagnosis of adenofibroma. For this she held her general practitioner (GP) responsible. In the ensuing legal battle the court expert testified that the GP had complied with the appropriate practice guideline.

When is the practice of pathology malpractice?

Because of its complex nature, surgical pathology diagnosis has an appreciable degree of fallibility and is increasingly subject to legal scrutiny. In litigation, the first practical step is to explain why and how this adversity could happen, and the second is the question of apportionment of responsibility and its legal consequences. As pathologists, we have to provide a methodology of investigation allowing a clear distinction between reasonable and unacceptable pathology practice without the twist of hindsight.

[Multidisciplinary oncology teams: beware of endless discussions].

The continual and increasing complexity of diagnostic and treatment options in oncology demands careful communication, coordination and decision making. Cancer care could be improved by multidisciplinary teamwork. Although this sort of teamwork has many advantages in theory, we know very little about its effectiveness in practice.

[Complaints about bureaucracy in health care? Time for a proactive medical profession].

Health care is in profound transition, its organization changing from being service-oriented to outcomes-oriented. Doctors are complaining of too much bureaucracy. However, the increasing complexity of healthcare demands rationalization, standardization and optimization of processes.

[Missed malignant melanoma: legal considerations].

Malignant melanoma may be missed both clinically and histopathologically. The appearance of metastases after local excision of a skin lesion which was not recognized as melanoma indicates a diagnostic error. In a lawsuit three things have to be proven: that the doctor has behaved negligently, that the patient has been damaged and that there is a causal relation between the two.

Risk analyses for screening sigmoidoscopy based on a colorectal cancer (CRC) population.

Objective: Although colonoscopy can be effective in the prevention of colorectal cancer (CRC), it requires many endoscopic facilities, has a high patient burden and risk of complications, and it is expensive. The aim of this study was to determine the risk for proximal CRC and to identify subgroups in which screening sigmoidoscopy can be effective.

Material And Methods: A database search was carried out on all patients who underwent endoscopy of the lower gastrointestinal (GI) tract between 1997 and 2005.

[Prognosis in patients operated on for colorectal carcinoma: related to but not determined by number of lymph nodes examined].

The presence or absence of lymph node metastases is pivotal for the estimation of prognosis in carcinoma patients. The presence of lymph node metastases in patients with colorectal carcinoma (CRC) is an indicator of poor prognosis and adjuvant treatment is increasingly being given to these patients. For the patient much depends on effective staging of CRC.

[New developments in medicine: walk-in clinics in supermarkets].

In the United States, the number of walk-in medical clinics in supermarkets is increasing rapidly. Although these clinics provide only a limited assortment of medical services, they constitute competition with primary healthcare and emergency medicine. Several factors have made the appearance of such medical clinics possible, including the strong emphasis being placed on the role of the market in medical care.

[On the occasion of the 65th birthday of the cervical smear: added value of population studies for cervical cancer remains unclear].

It was in 1941 that George Papanicolaou first published his article on the use of the vaginal smear for the detection of cancer. It was generally believed that this simple test would be a blessing for women and could ultimately eradicate death from cervical cancer. Several decades later it has become clear that complexity dominates the picture of this test and not simplicity.

[Performance indicators unsuitable to monitor and improve complex health care].

Medically, socially and legally doctors are expected to deliver care of sufficient quality. Adequate quality is never self-evident. Patients and payers increasingly demand public disclosure of the condition ofhealthcare.

[The Medical Code of Practice: clear reasons for existing, benefit less certain].

The Medical Code of Practice (Dutch acronym TG) aims to maintain and advance the quality of professional practice. Working together, lawyers and medical practitioners consider and make judgements on the procedures and methods practiced by caregivers. They also aim to protect citizens against the inexpert and careless execution of medical practice.

Attendance at surveillance endoscopy of patients with adenoma or colorectal cancer.

Objective: Surveillance of patients treated for adenoma or colorectal cancer (CRC) is intended to reduce the incidence of CRC. Responsibility for the adherence to surveillance advice is often left to the patients and family physician. It is not known whether this type of passive policy affects the efficacy of surveillance.

[Cancer registries and the quality of oncological care].

In 1971, President Nixon of the US declared war on cancer. To ascertain what progress has been made since then, national cancer registries may provide informative data. However, if standardised morbidity and mortality summary rates for cancer are dropping, we cannot conclude that there is a causal relation between increased diagnostic or therapeutic efforts and this decline.

[Top 100 hospitals: varying lists, varying reputations].

In the month of September no fewer than 3 different hospital rankings appeared in the media. These rankings do not reliably portray the quality of hospitals. Since they mutually differ substantially, they provide insufficient information to motivate hospitals with lower scores to make meaningful improvements, and they only partly influence the choice of patients.

[Emergency procedures for taking care of the victims of bomb attacks: logistical and medical aspects].

In The Netherlands the threat of terrorist attacks also exist. Both doctors and hospitals alike should be prepared for such attacks both on the logistical as well as the medical level. Most terrorist attacks are carried out with explosives.