Association between onychomycosis and ulcerative complications in patients with diabetes: a longitudinal cohort study in Dutch general practice.

Introduction: Diabetic foot ulcers are feared complications of diabetes mellitus (DM), requiring extensive treatment and hospital admissions, ultimately leading to amputation and increased mortality. Different factors contribute to the development of foot ulcers and related complications. Onychomycosis, being more prevalent in patients with diabetes, could be an important risk factor for developing ulcers and related infections.

Severe drug eruption from oral terbinafine for mild onychomycosis-A case report from family practice and literature review: "Just an innocent little pill?".

Onychomycosis is the most prevalent nail disease and is frequently encountered in clinical practice. Despite having multiple therapeutic options, of which systemic antifungals are the most effective, treatment is not always mandatory in all patients. Especially when considering systemic treatment, the risk of adverse reactions may outweigh the potential benefits of treatment.

Artificial intelligence in mobile health for skin cancer diagnostics at home (AIM HIGH): a pilot feasibility study.

Background: Artificial intelligence (AI)-based mobile phone apps (mHealth) have the potential to streamline care for suspicious skin lesions in primary care. This study aims to investigate the conditions and feasibility of a study that incorporates an AI-based app in primary care and evaluates its potential impact.

Methods: We conducted a pilot feasibility study from November 22nd, 2021 to June 9th, 2022 with a mixed-methods design on implementation of an AI-based mHealth app for skin cancer detection in three primary care practices in the Netherlands (Rotterdam, Leiden and Katwijk).

The accuracy of clinical diagnosis of onychomycosis in Dutch general practice: a diagnostic accuracy study.

Background: Onychomycosis, the most common cause of nail dystrophy, is generally diagnosed by clinical examination. Current guidelines for Dutch general practice advise confirmatory testing only in cases of doubt or insufficient response to treatment. However, making a correct diagnosis can be challenging given the wide variety of clinical features and differential diagnosis.

Natural course of cutaneous warts among primary schoolchildren: a prospective cohort study.

Purpose: Because cutaneous warts resolve spontaneously and available treatments often fail, family physicians and patients may consider a wait-and-see policy. We examined the natural course of cutaneous warts and treatment decisions in a prospective observational cohort of primary schoolchildren.

Methods: We inspected the hands and feet of children aged 4 to 12 years from 3 Dutch primary schools for the presence of warts at baseline and after a mean follow-up of 15 months.

Warts transmitted in families and schools: a prospective cohort.

Background And Objective: Cutaneous warts are common in primary schoolchildren; however, knowledge on the routes of transmission of human papillomavirus (HPV) causing warts is scarce. This study examines the association between the degree of HPV exposure and incidence of warts in primary schoolchildren to support evidence-based recommendations on wart prevention.

Methods: In this prospective cohort study, the hands and feet of all children in grades 1 to 7 (aged 4-12 years) of 3 Dutch primary schools were inspected for the presence of warts at baseline and after 11 to 18 months of follow-up.

HPV type in plantar warts influences natural course and treatment response: secondary analysis of a randomised controlled trial.

Background: Cryotherapy is effective for common warts, but for plantar warts available treatments often fail.

Objectives: Within a pragmatic randomised controlled trial, we examined whether subgroups of common and plantar warts have a favourable natural course or response to treatment based on wart-associated HPV type.

Study Design: Consecutive patients with new common or plantar warts were recruited in 30 Dutch family practices.

[Actinic keratosis: the art of doing nothing].

General practitioners are frequently consulted to assess a variety of skin lesions. Actinic keratoses account for an important number of those discovered spontaneously by physicians, especially in elderly patients; they then wonder whether or not they should treat these precancerous lesions, which may become invasive and may transform into squamous cell carcinoma. However, there are clear therapeutic guidelines in place.

Cutaneous wart-associated HPV types: prevalence and relation with patient characteristics.

Background: Epidemiological data on cutaneous wart-associated HPV types are rare.

Objectives: To examine the prevalence of cutaneous wart-associated HPV types and their relation with patient characteristics.

Study Design: Swabs were taken from all 744 warts of 246 consecutive immunocompetent participants and analysed by a broad spectrum HSL-PCR/MPG assay.

Proximity to death is associated with frequency of GP contacts in the oldest old: the Leiden 85-plus study.

Background: the relationship between proximity to death and the amount of care provided by general practitioners (GPs) is largely unknown.

Objective: to examine the influence of the proximity to death on the frequency and length of GP contacts in the oldest old.

Study Design: this population-based follow-up study included 599 inhabitants of Leiden, the Netherlands.

Interventions for ingrowing toenails.

Background: Ingrowing toenails are a common problem in which part of the nail penetrates the skinfold alongside the nail, creating a painful area. Different non-surgical and surgical interventions for ingrowing toenails are available, but there is no consensus about a standard first-choice treatment.

Objectives: To evaluate the effects of non-surgical and surgical interventions in a medical setting for ingrowing toenails, with the aim of relieving symptoms and preventing regrowth of the nail edge or recurrence of the ingrowing toenail.

Trichodysplasia spinulosa is characterized by active polyomavirus infection.

Background: Recently a new polyomavirus was identified in a patient with trichodysplasia spinulosa (TS), a rare follicular skin disease of immunocompromised patients characterized by facial spines and overgrowth of inner root sheath cells. Seroepidemiological studies indicate that TSPyV is ubiquitous and latently infects 70% of the healthy individuals.

Objective: To corroborate the relationship between active TSPyV infection and TS disease by analyzing the presence, load, and precise localization of TSPyV infection in TS patients and in controls.

[Childhood diseases with exanthema].

- Due to high vaccination coverage, measles and rubella (German measles) are now rarely seen in the Netherlands, which makes recognition of these diseases difficult. - Measles can also occur in people who have been immunized, as a result of vaccination failure. - Swift recognition of measles and rubella is necessary in order to manage them adequately and to prevent spreading of the disease.

Evaluation of a novel multiplex human papillomavirus (HPV) genotyping assay for HPV types in skin warts.

Human papillomaviruses (HPV) of the genera alpha, mu, and nu induce benign tumors of the cutaneous epithelia that constitute a significant burden for immunocompromised adults. Currently, no gold standard for genotyping of these HPV types exists. In this study, we describe the prevalence of genus alpha, mu, and nu HPV types in cutaneous warts.

Design of the Verbiest trial: cost-effectiveness of surgery versus prolonged conservative treatment in patients with lumbar stenosis.

Background: Degenerative changes of lumbar spine anatomy resulting in the encroachment of neural structures are often regarded progressive, ultimately necessitating decompressive surgery. However the natural course is not necessarily progressive and the efficacy of a variety of nonsurgical interventions has also been described. At present there is insufficient data to compare surgical and nonsurgical interventions in terms of their relative benefit and safety.

[A snail leaves trails--how delayed provision of information affects the general practitioner and patient].

Two patients were seen by medical specialists at hospital, but the general practitioner received their discharge letters too late. The first patient was a man aged 50 referred to the emergency department of the hospital with suspected pulmonary embolism. He was sent home and was found dead two days later.

Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: randomized controlled trial.

Background: Cryotherapy is widely used for the treatment of cutaneous warts in primary care. However, evidence favours salicylic acid application. We compared the effectiveness of these treatments as well as a wait-and-see approach.

Current choices in the treatment of cutaneous warts: a survey among Dutch GP.

Background: GPs apply several treatments for patients with cutaneous warts. Available evidence recommends salicylic acid application.

Objective: We investigated whether current choices of GPs in the treatment of warts are in agreement with available evidence.

Evaluation of a novel broad-spectrum PCR-multiplex genotyping assay for identification of cutaneous wart-associated human papillomavirus types.

A large number of human papillomavirus (HPV) types, distributed over five papillomavirus genera, are detectable in the skin. HPV types belonging to the alpha, gamma, and mu genera have been detected in cutaneous warts. A state-of-the-art HPV genotyping assay for these cutaneous wart-associated HPV types does not exist although warts constitute a highly prevalent skin condition, especially in children (33%) and organ transplant recipients (45%).

Medically unexplained physical symptoms in primary care: a controlled study on the effectiveness of cognitive-behavioral treatment by the family physician.

Background: Disabling medically unexplained physical symptoms occur in 16% of all patients in primary care.

Objective: The aim of this study was to assess the effectiveness of a cognitive-behavioral intervention by the family physician.

Method: In a controlled design with detailed information on patient selection, 6,409 patients were screened on somatoform disorder, and 65 participants were allocated to care-as-usual or the experimental condition.

The role of comorbidity in the detection of psychiatric disorders with checklists for mental and physical symptoms in primary care.

Objective: To examine the contribution of a mental and physical symptom count to the detection of single or comorbid anxiety, depressive and somatoform disorders.

Method: In primary care 1,046 consulting patients completed the Hospital Anxiety and Depression Scale (HADS) and the Physical Symptom Checklist (PSC-51). In a stratified sample of 473 patients DSM-IV psychiatric disorders were assessed using the WHO-SCAN interview.

Referral patterns between the child health service, general practitioners, and secondary healthcare: a prospective descriptive study in the Netherlands.

Background: In the Netherlands, preventive child health service (CHS) screening plays an important role in the early detection of congenital, developmental, physical, and mental disorders.

Objective: To obtain insight into the referral patterns of children from CHS to general practitioners and from general practitioners to medical specialists.

Methods: Prospective study over 6 months in a semi-urban area in the Netherlands.

Follow-up study on health care use of patients with somatoform, anxiety and depressive disorders in primary care.

Background: Better management of affective and somatoform disorders may reduce consultation rates in primary care. Somatoform disorders are highly prevalent in primary care and co-morbidity with affective disorders is substantial, but it is as yet unclear which portion of the health care use may be ascribed to each disorder. Our objective was to investigate the use of primary care for undifferentiated somatoform disorders, other somatoform disorders, anxiety and depressive disorders prospectively.

Surgery versus prolonged conservative treatment for sciatica.

Background: Lumbar-disk surgery often is performed in patients who have sciatica that does not resolve within 6 weeks, but the optimal timing of surgery is not known.

Methods: We randomly assigned 283 patients who had had severe sciatica for 6 to 12 weeks to early surgery or to prolonged conservative treatment with surgery if needed. The primary outcomes were the score on the Roland Disability Questionnaire, the score on the visual-analogue scale for leg pain, and the patient's report of perceived recovery during the first year after randomization.