[Deviating from guideline-recommended diagnostic work-up in general practice: examples involving high-sensitivity troponin and CRP testing].

While clinical guidelines are essential for decision-making based on the latest evidence, they are not all-encompassing for any given patient or context. As such, deviating from guideline recommendations is common practice and can be attributed to contextual, ethical, clinical, or scientific factors. In the setting of diagnostic testing deviating from recommended diagnostic work-up may result in both over- and under-testing.

[Environmental impact of inhalers in the Netherlands and worldwide: the facts at a glance].

Hydrofluorocarbons (HFCs) released from the use of metered-dose inhalers (MDIs) contribute significantly to climate change. Counterintuitively, these HFCs indirectly cause health damage to asthma and COPD patients, as climate change creates more summer smog and pollen in the air. European regulation is urgently needed to ensure that only MDIs with HFCs with a lower global warming potential will be produced in future.

Turning green: the impact of changing to more eco-friendly respiratory healthcare - a carbon and cost analysis of Dutch prescription data.

Objectives: Dry powder inhalers (DPIs) and soft mist inhalers have a substantially lower global warming potential than pressurised metered-dose inhalers (pMDIs). To help mitigate climate change, we assessed the potential emission reduction in CO equivalents when replacing pMDIs by non-propellant inhalers (NPIs) in Dutch respiratory healthcare and estimated the associated cost.

Design: We performed a descriptive analysis of prescription data from two national databases of two independent governmental bodies.

[No place for ondansetron in young children with gastroenteritis and persistent vomiting].

At several out-of-hours services primary care, a single dose of ondansetron was compared with standard care (oral rehydration solution (ORS)) in young children with gastroenteritis and persistent vomiting. Although vomiting decreased more often in the ondansetron group compared to the control group in the first hours, ondansetron had no effect on ORS use and did not lead to fewer referrals to the hospital. Unfortunately, the outcome measure diarrhoea was missing as a possible adverse effect of ondansetron.

The Development of Practice Recommendations for Drug-Disease Interactions by Literature Review and Expert Opinion.

Background: Drug-disease interactions negatively affect the benefit/risk ratio of drugs for specific populations. In these conditions drugs should be avoided, adjusted, or accompanied by extra monitoring. The motivation for many drug-disease interactions in the Summary of Product Characteristics (SmPC) is sometimes insufficiently supported by (accessible) evidence.

[Diagnostics on suspicion of a bleeding disorder].

Bleeding symptoms occur frequently in the general population, but the possibility of an underlying bleeding disorder is not always recognised. Women with a bleeding disorder are disproportionally affected due to blood loss during menstruation and giving birth. Taking a thorough family history and a history of bleeding are most important in the workup to detect a potential underlying bleeding disorder.

Treatment of Lower Extremity Superficial Thrombophlebitis.

Clinical Question: Which treatments for lower extremity superficial thrombophlebitis (ST) are associated with lower rates of venous thromboembolic events (VTEs) vs placebo?

Bottom Line: A dose of 2.5 mg of fondaparinux administered subcutaneously once daily for 45 days is associated with fewer cases of symptomatic VTE without an increase in major bleeding vs placebo. Low-molecular-weight heparin (LMWH) and nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with lower rates of ST extension or recurrence vs placebo, but data regarding symptomatic VTE remain inconclusive.

Treatment for superficial thrombophlebitis of the leg.

Background: The optimal treatment of superficial thrombophlebitis (ST) of the legs remains poorly defined. While improving or relieving the local painful symptoms, treatment should aim at preventing venous thromboembolism (VTE), which might complicate the natural history of ST. This is the third update of a review first published in 2007.

[Hope-Simpson and shingles].

Dr Robert Edgar Hope-Simpson (1908-2003) was a British general practitioner, who has laid the foundation for unravelling the pathogenesis of shingles. At the beginning of the 20th century, both conditions were known to be related, but the precise relationship was unclear. It was assumed that chickenpox could originate after infection by both a person with shingles or someone with chickenpox, but that both diseases were caused by different viruses.

[NHG 'Traumatic wounds and bite wounds' treatment guideline].

- The 'Traumatic wounds and bite wounds' treatment guideline by the NHG (Dutch College of General Practitioners) has recommendations for treating traumatic wounds, bite wounds and wound infection.- It is important to distinguish between traumatic wounds and bite wounds because treatment of lacerations and cuts differs from treatment of bites.- Clean a wound under a lukewarm water tap; avoid using disinfectants.

Treatment for superficial thrombophlebitis of the leg.

Background: The optimal treatment of superficial thrombophlebitis (ST) of the legs remains poorly defined. While improving or relieving the local painful symptoms, treatment should aim at preventing venous thromboembolism (VTE), which might complicate the natural history of ST. This is the second update of a review first published in 2007.

Treatment for superficial thrombophlebitis of the leg.

Background: The optimal treatment of superficial thrombophlebitis (ST) of the legs remains poorly defined. While improving or relieving the local painful symptoms, treatment should aim at preventing venous thromboembolism (VTE), which might complicate the natural history of ST. This is an update of a review first published in 2007.

High levels of protein C are determined by PROCR haplotype 3.

Background: Genetic determinants of plasma levels of protein C (PC) are poorly understood. Recently, we identified a locus on chromosome 20 determining high PC levels in a large Dutch pedigree with unexplained thrombophilia. Candidate genes in the LOD-1 support interval included FOXA2, THBD and PROCR.

Assessment of coagulation and fibrinolysis in families with unexplained thrombophilia.

Despite knowledge of various inherited risk factors associated with venous thromboembolism (VTE), no definite cause can be found in about 50% of patients. The lack of an intermediate phenotype in VTE impedes the discovery of new familial risk factors. We set out to define an intermediate phenotype for VTE by performing global coagulation analyses in unexplained thrombophilic families.

A retrospective analysis of patients treated for superficial vein thrombosis.

Introduction: The absolute risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) as well as extension and/or recurrence in superficial vein thrombosis (SVT) of the leg is considerable and underestimated. We retrospectively evaluated therapeutic management, thrombophilic risk factors and clinical outcome of SVT.

Methods: A database search was performed for consecutive patients with a suspected SVT of the lower extremities referred to our institution between 1 January 1999 and 31 December 2004.

Treatment for superficial thrombophlebitis of the leg.

Background: The optimal treatment of superficial thrombophlebitis (ST) of the legs remains poorly defined. While improving or relieving the local painful symptoms, treatment should aim at preventing venous thromboembolism (VTE), which might complicate the natural history of ST.

Objectives: To assess the efficacy and safety of topical, medical, and surgical treatments in patients presenting with ST of the legs.

Treatment for superficial thrombophlebitis of the leg.

Background: The optimal treatment of superficial thrombophlebitis (ST) of the legs remains poorly defined. While improving or relieving the local painful symptoms, treatment should aim at preventing venous thromboembolism (VTE), which might complicate the natural history of ST.

Objectives: To assess the efficacy and safety of topical, medical, and surgical treatments in patients presenting with ST of the legs.

Spontaneous superficial venous thrombophlebitis: does it increase risk for thromboembolism? A historic follow-up study in primary care.

Objective: To determine the risk of arterial and venous complications after a spontaneous superficial venous thrombophlebitis (SVTP) in the leg in a general practice population.

Study Design: Retrospective cohort study (LOE: 2b [CEBM]). Exposure consisted of the diagnosis of SVTP of the lower limbs on an index date.

Treatment of superficial vein thrombosis to prevent deep vein thrombosis and pulmonary embolism: a systematic review.

Background And Objectives: The aim of this systematic review was to summarize the evidence from randomized controlled trials (RCT) concerning the efficacy and safety of medical or surgical treatments of superficial vein thrombosis (SVT) for the prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE).

Design And Methods: A systematic search was performed in MEDLINE, EMBASE and the Cochrane (CENTRAL) database to identify all randomized trials that evaluated the effect of surgical or medical treatment in the prevention of venous thromboembolism (VTE) in patients with SVT of the legs.

Results: Five studies were included.

Use of ML dipstick as a tool to classify leprosy patients.

Leprosy control services face the problem of leprosy patients being misclassified by the lack of or the poor quality of skinsmear examination services. Misclassification increases the risk of relapse due to insufficient treatment if a multibacillary (MB) patient is classified as paucibacillary (PB), thereby also prolonging the time that the patient is infectious. The World Health Organization (WHO) recommends at present an alternative classification based on the number of skin lesions.