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Objective: To study the extent to which follow-up diagnostics, referral to secondary care and follow-up are in accordance with the practice guideline of the Dutch College of General Practitioners 'Viral hepatitis and other liver disorders' after a hepatitis B (HBV) or C (HCV) infection has been diagnosed at the general practice., Design: Retrospective cohort study., Method: Patient records were obtained from the Dutch 'Integrated primary care information' (IPCI) database which contains data from patients from general practices. Records of patients with a first-time positive HBsAg or anti-HCV test result in the period between 2008 and 2015 were manually validated and data on follow-up diagnostics, referral and follow-up were found., Results: A total of 117 patients tested positive for HBsAg and 101 patients tested positive for anti-HCV. Most HBV patients were subsequently tested for HBeAg (92%) and ALT (80%). Of the 41 HBV patients who were eligible for referral, 37 (90%) were actually referred to a specialist. 49 HCV patients (49%) were found negative after a confirmation or RNA test. 87% of the remaining 52 HCV patients were referred (n = 45). 21 (43%) of the 49 HBV patients who were not eligible for referral were tested for ALT after an average of 11.5 months. 14 (29%) of these patients subsequently received a second follow-up ALT test and 8 (16%) received a third., Conclusion: Almost all HBV and HCV patients who are eligible for referral, are actually referred to a specialist. Most HBV patients received the correct follow-up diagnostics after a positive HbsAg test result. However, in few HBV patients who were not eligible for referral, was the ALT level checked every year for three years. The general practitioner, as well as the patient, should receive a reminder for this.

Objective: To study the association between the use of spironolactone and the risk of upper gastrointestinal bleeding or ulcers., Design: Case-control study., Method: The study used the computerized 'integrated primary care information' (IPCI) database in the Netherlands. All persons, 18 years or older during the study period from January 1st 1996 through September 30th 2003 with at least one year of valid case history were included. Patients with a medical history of alcoholism or gastrointestinal cancer were excluded. For each case of gastroduodenal ulcer or upper gastrointestinal bleeding, 10 controls were sampled from the same database, matched on age (year of birth), gender and index date. The association between the use ofspironolactone, calculated from the number of general practitioners' prescriptions, and the occurrence of an upper gastrointestinal event (upper gastrointestinal bleeding or ulcers) was analysed by means of a conditional logistic regression analysis., Results: Within the source population of 306,645 patients, 523 cases with gastric or duodenal ulcers or upper gastrointestinal bleeding were identified and matched with 5,230 controls. Current use of spironolactone was associated with a 2.7-fold (adjusted odds ratio (OR); 95% CI: 1.2-6.0) increased risk of gastrointestinal events. This risk was higher in patients on high dosages and was the highest in patients using spironolactone in combination with an ulcerogenic drug (NSAIDs, platelet aggregation inhibitors, corticosteroids or vitamin K antagonist) (adjusted OR: 7.3; 95% CI: 2.9-18.7)., Conclusion: The risk of upper gastrointestinal bleeding or ulcer was increased 2.7 times when spironolactone was used.

This paper aims in analyzing the effectiveness of the technological impact of internet technology on nuclear medicine. To make this evaluation we will first determine what we consider is the 'internet technology' and then see how the 'production line' in nuclear medicine benefits from this internet technology, putting both side by side.

By means of rhinomanometry, analogue physiological transnasal pressure and corresponding flow signals are simultaneously recorded during quiet nasal breathing. In order to describe the sigmoid shaped pressure/flow curves or relationship, several mathematical models have been developed. In this study, the authors wanted to demonstrate which model best describes the curvilinearity of the pressure/flow curves. By their approach, they found that polynomial models like delta p = K0 + K1V + K2V2 as well as the Broms' polar coordinate model best fit the recorded pressure/flow data. Since the parameters and exponents of such a model characterize the degree of laminar and turbulent behaviour of transnasal flow, a diagnostic potential may be offered in the future, to qualify and quantify the phenomenon of nasal obstruction.

The purpose of this correspondence is to point out that the scaling procedure (as well as any nonsingular transformation) described in Section VI of the above paper1 is unnecessary.