Nederlands tijdschrift voor geneeskunde

Publisher: Kluwer

Journal description

De lange historie en de grote degelijkheid en leesbaarheid van het tijdschrift maken het tot een bolwerk van medische wetenschap in druk, voortdurende dialoog over het medisch ambt. Het tijdschrift wordt gelezen door artsen en aankomend artsen van velerlei signatuur. Het NTVG staat bekend als een wetenschappelijk algemeen medisch tijdschrift.

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Website Nederlands Tijdschrift voor Geneeskunde website
Other titles Nederlands tijdschrift voor geneeskunde
ISSN 1876-8784
OCLC 1642618
Material type Periodical
Document type Journal / Magazine / Newspaper

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Authors own final version can be archived
    • Publisher's protected PDF can be used for a fee
    • Published source must be acknowledged
    • Must link to publisher version
    • Articles in some journals can be made Open Access on payment of additional charge
    • 'Kluwer' is an imprint of 'Springer Verlag (Germany)'
  • Classification
    ​ green

Publications in this journal

  • Nederlands tijdschrift voor geneeskunde 03/2015; 159:A8144.
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    ABSTRACT: Doel Inzicht verkrijgen in hoe patiënten bij een bepaald ziekenhuis terecht komen en waarom het keuzegedrag van veel patiënten niet overeenkomt met dat van de ‘actieve patiënt’ die beleidsmakers voor ogen hadden toen zij het Nederlandse zorgstelsel hervormden. Opzet Semigestructureerde interviews met poliklinische patiënten van 2 afdelingen in 3 ziekenhuizen. Methode De interviews werden gehouden, opgenomen, getranscribeerd en geanalyseerd volgens de ‘grounded theory approach’. Resultaten Er zijn 142 interviews gehouden. Wij onderscheidden 3 niveaus die weergeven hoe actief patiënten hun keuze maakten: passief, semi-actief en actief. Passieve patiënten gingen naar het voor de hand liggende ziekenhuis zonder kwaliteitsinformatie te gebruiken of alternatieven te overwegen, terwijl actieve patiënten zowel informatie gebruikten als alternatieven overwogen. Verschillende factoren beïnvloedden het keuzeproces. Op basis van deze factoren en de mate waarin patiënten actief kozen, konden we patiënten classificeren in 5 types, waaronder patiënten die door hun ziekteproces geen keuze hadden en patiënten die voldeden aan het beeld van de actieve patiënt die beleidsmakers voor ogen hebben. Conclusie Al variëren patiënten in de manier waarop ze een ziekenhuis kiezen of, passiever geformuleerd, hoe ze ergens terecht komen, de meeste geïnterviewde patiënten gingen naar het voor de hand liggende ziekenhuis. Deze patiënten zien geen reden om actief te kiezen of hebben het idee dat ze geen keuzemogelijkheid hebben. Het idee van actief kiezende patiënten komt voort uit het marktdenken, maar dit onderzoek wijst uit dat principes uit deze wereld niet altijd passen in de zorg. Toch waarderen patiënten het om te kunnen kiezen voor ‘hun’ ziekenhuis. URL:
    Nederlands tijdschrift voor geneeskunde 01/2015; 159(A8164).
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    ABSTRACT: After the publication of the Dutch medical guideline on pharmacological analgesia during childbirth in 2008, the question of whether pharmacological pain relief should be permissible during labour was hotly debated. This discussion has been going on since the second half of the 19th century when the introduction of ether and chloroform was extensively studied and described in Great Britain. This article looks back on the same debate in the Netherlands when inhalational anaesthetics were introduced into obstetrics.
    Nederlands tijdschrift voor geneeskunde 01/2015; 159:A8475.
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    ABSTRACT: Management of obstetric emergencies is difficult to learn in real life due to the rarity of emergency events. Simulation-based medical education (SBME) has been shown to be a useful training method. A safe learning environment is a crucial condition for successful, applicable SBME. It is therefore essential to understand how SBME is perceived by healthcare professionals. A study by Sørensen et al. published recently in Postgraduate Medical Journal found that the number of staff members with positive perceptions increased after unannounced in situ simulation of obstetric emergencies. However, the number of staff who viewed the simulation as stressful also increased, especially among midwives. Although this study had some limitations, these results should be taken seriously. Randomised trials are warranted to explore the perceptions of healthcare professionals with regard to SBME.
    Nederlands tijdschrift voor geneeskunde 01/2015; 159:A8635.
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    ABSTRACT: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited cardiac arrhythmia syndrome. CPVT is characterised by polymorphic ventricular arrhythmias induced by exercise or emotion. These arrhythmias may lead to sudden death. We describe 2 patients with CPVT: a 38-year-old asymptomatic male with a family history of sudden death at a young age, and a 28-year-old woman who suffered from recurrent syncopal episodes triggered by exercise or emotion. In both of these cases the diagnosis CPVT was missed initially, even though the typical arrhythmias were present during exercise tests. CPVT should be considered in young patients who present with syncopal episodes during exercise or emotions, or who display polymorphic ventricular arrhythmias. Family history can also be indicative, particularly if family members have died suddenly at a young age under similar circumstances.
    Nederlands tijdschrift voor geneeskunde 01/2015; 159:A8205.
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    ABSTRACT: Reporting guidelines have been developed for randomized clinical trials, systematic reviews, and many other types of studies. Most of these have a checklist of essential items that have to be included in every study report. Describing these essential items enables readers to better judge the validity, relevance and applicability of study findings. The website of the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network now lists more than 200 such reporting guidelines. While they have been endorsed by many journals and other organizations, uptake has been incomplete. The implicit assumption in many guidelines was that editors of scientific journals would police authors, thereby enforcing the use of the checklists. We argue that the groups responsible for reporting guidelines could put more effort into the development of tools for authors, reviewers and editors to facilitate the implementation of these guidelines. This would contribute to completeness and transparency in reporting clinical and biomedical research.
    Nederlands tijdschrift voor geneeskunde 01/2015; 159:A8797.
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    ABSTRACT: A 56-year-old man came to the general practitioner with a solitary compressible swelling on his left forearm, which enlarged during exercise. The patient reported a history of bodybuilding and he worked as a plasterer. Physical examination revealed primary varicose of the upper extremity, a rare localisation of a common vascular disease.
    Nederlands tijdschrift voor geneeskunde 01/2015; 159:A8522.
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    ABSTRACT: Alcohol hallucinosis is a rare complication of chronic alcohol abuse characterized by the acute onset of hallucinations during or after an episode of alcohol use. The hallucinations may persist for a long time, due to which the clinical picture can be mistaken for a disorder on the schizophrenia spectrum. The prognosis tends to be favourable, although untreated cases are associated with a considerable mortality risk (37% in eight years). A 38-year-old male was admitted to a psychiatric hospital with hallucinations of acute onset during alcohol abuse which persisted for two months of abstinence. The patient experienced visual, auditory and tactile hallucinations during which time his consciousness, attention, orientation and higher cognitive functions remained intact. Somatic and neuroimaging investigations showed no abnormalities. The patient partially recovered on treatment with haloperidol. If hallucinations are experienced during or after a period of alcohol abuse, the diagnosis of alcohol hallucinosis should be considered. The diagnosis must be distinguished from delirium tremens and schizophrenia spectrum disorder as treatment and prognosis are essentially different.
    Nederlands tijdschrift voor geneeskunde 01/2015; 159:A7901.
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    ABSTRACT: - Effect modification and interaction are terms often used in medical research. However, the analysis of effect modification and interaction has differing objectives. These two phenomena require different methods of analysing and presenting.- Effect modification means that the association under study differs between certain subgroups, e.g. men and women. The aim is to identify clinically relevant subgroups, without the need to know the underlying cause of the modification. The presence and direction of effect modification may depend on the effect measure, e.g. risk difference or risk ratio. - Interaction means that the combination of two determinants has more or less effect than each of the determinants separately. The aim is to estimate the causal relationship between these two determinants and the outcome as accurately as possible. Interaction can be calculated on an additive or multiplicative scale.
    Nederlands tijdschrift voor geneeskunde 01/2015; 159:A8499.
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    ABSTRACT: A neonate was born with a sacrococcygeal mass. Initially, spina bifida was suspected. However, neurological examination was unremarkable. An MRI of the neuraxis showed a large cystic presacral lesion without signs of spina bifida. Surgical resection of the lesion was performed. Pathologic evaluation confirmed the diagnosis of a sacrococcygeal teratoma.
    Nederlands tijdschrift voor geneeskunde 01/2015; 159:A8313.
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    ABSTRACT: During a routine physical examination of a term, healthy neonate of Somalian origin we observed an anteriorly located interlabial yellow cyst with visible vascularisation on the outer surface. It caused lateralisation of the urinary meatus without notable obstruction. A Skene's duct cyst, or paraurethral cyst, was clinically diagnosed with spontaneous regression. This is a self-limiting phenomenon of unknown origin that rarely requires surgical drainage in case of urinary obstruction.
    Nederlands tijdschrift voor geneeskunde 01/2015; 159:A8355.
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    ABSTRACT: Monitoring contractions during labour using the external tocodynamometer can be difficult or even impossible, and using the invasive intrauterine pressure catheter is associated with rare but serious complications. A new non-invasive technique is currently available: electrohysterography (EHG). This technique converts the electrical activity of the uterine muscle into a legible tocogram. The EHG signal has a high correlation with the intra-uterine pressure and provides a more accurate assessment of uterine activity compared to external tocodynamometry. EHG is suitable for women in labour with failure of the external tocodynamometer. In clinical practice EHG also appeared to report a more detailed tocographic waveform, like hypertonia or unorganized electrical uterine activity. However, its signal quality depends on adequate skin preparation and correct positioning of the electrodes on the maternal abdomen. Hence, with electrohysterography as non-invasive alternative for uterine monitoring, choosing between safety and accuracy is no longer necessary.
    Nederlands tijdschrift voor geneeskunde 01/2015; 159:A8535.
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    ABSTRACT: The Netherlands has a demand-driven health care system based on market mechanisms. However, the system is a hybrid between two potential situations: one in which healthcare insurance companies have a leading role, with consumers and patients choosing for the company that most suits them, and one in which patients have a leading role and select their favourite caregiver, whereby the insurance company has to follow. Current research concludes that the vast majority of patients are not able or even willing to choose, but instead place their trust in referring physicians and local hospitals. Additionally, many patients feel that they are not capable of making informed choices. If patients cannot or do not want to choose their healthcare providers, then one of the mainstays of a market-based health care system should perhaps be seriously re-evaluated.
    Nederlands tijdschrift voor geneeskunde 01/2015; 159:A8664.
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    ABSTRACT: Between around 1620 and the end of the eighteenth century, every surgeon working in Amsterdam was presented with a guild medal on passing their surgeon's exams. These medals actually represented membership of the Surgeon's Guild of Amsterdam and could be used as proof of attendance at meetings of the Guild. From 1864 onwards surgeons also received the Hortus medal, which allowed them entry to the Hortus Medicus. Less common medals include medals for ensuring the surgeon's apprentices attended lectures, funeral medals for ensuring correct procedures regarding casket bearing duties were followed at a funeral, and medals of honour recognising services to the Guild. The collection of 17th and 18th century Amsterdam Surgeon's Guild medals numbers some 230 examples, and is the largest and most varied collection of its kind in the world. A few of the medals that have been preserved actually belonged to surgeons depicted in the famous series of group portraits. We examined who these surgeons were and what the purpose of these medals was.
    Nederlands tijdschrift voor geneeskunde 01/2015; 159:A8647.
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    ABSTRACT: To determine the predictive value of safety management system (VMS) screening questions for falling, delirium, and mortality, as punt down in the VMS theme 'Frail elderly'. Retrospective observational study. We selected all patients ≥ 70 years who were admitted to non-ICU wards at the Deventer Hospital, the Netherlands, for at least 24 hours between 28 March 2011 and 10 June 2011. On admission, patients were screened with the VMS instrument by a researcher. Delirium and falls were recorded during hospitalisation. Six months after hospitalisation, data on mortality were collected. We included 688 patients with a median age of 78.7 (range: 70.0-97.1); 50.7% was male. The sensitivity of the screening for delirium risk was 82%, the specificity 62%. The sensitivity of the screening for risk of falling was 63%, the specificity 65%. Independent predictors for mortality within 6 months were delirium risk (odds ratio (OR): 2.3; 95% CI 1.1-3.2), malnutrition (OR: 2.1; 95% CI 1.3-3.5), admission to a non-surgical ward (OR: 3.0; 95% CI 1.8-5.1), and older age (OR: 1.1; 95%CI 1.0-1.1). Patients classified by the VMS theme 'Frail elderly' as having more risk factors had a higher risk of dying (p < 0.001). The VMS screening for delirium is a reasonably reliable instrument for identifying those elderly people with a high risk of developing this condition; the VMS sensitivity for fall risk is moderate. The number of positive VMS risk factors correlates with mortality and may therefore be regarded as a measure of frailty.
    Nederlands tijdschrift voor geneeskunde 01/2015; 159:A8491.
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    ABSTRACT: The clinical condition "winged scapula" (scapula alata) is frequently not recognized as such. The accompanying symptoms are often attributed to more frequently occurring shoulder disorders, which can lead to unnecessary surgical procedures. A 41-year-old man was shot during a robbery 3 years ago, resulting in a complete paraplegia from the fourth thoracic vertebra downwards. Within a year of the attack, during rehabilitation towards wheelchair use, he developed pain around his right shoulder. He also had diminished strength when extending his right arm and problems with trunk balance. These symptoms were long thought to be caused by shoulder overuse during wheelchair use, but turned out to be a consequence of injury to the long thoracic nerve. Shoulder symptoms due to scapula alata can be caused be a penetrating wound leading to nerve injury. The treatment of patients with a scapula alata calls for a multidisciplinary approach.
    Nederlands tijdschrift voor geneeskunde 01/2015; 159:A8223.