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Despite advances in the prevention and management of chemotherapy-induced nausea and vomiting (CINV), these side effects remain among the most distressing for patients. We discuss the systematic review and meta-analysis by Patel et al (2022) evaluating effective and safe interventions to prevent acute phase CINV in adult and pediatric patients. With the advent of newer antiemetics during the last few decades, the incidence of CINV has improved especially for patients receiving highly emetogenic chemotherapy. Control of nausea remains an unmet need. Data on antiemetic safety are lacking. Future research should focus on patients receiving multiple-day chemotherapy, moderately emetogenic chemotherapy, but also on patients treated with low or minimally emetogenic chemotherapy. The identification of patients at high risk for CINV based on key patient-related risk factors prior to the initiation of a chemotherapy regimen is imperative, but in our view, these factors are not adequately taken into account.

Hydrocephalus is a rare diagnosis and can be mistaken for dementia in elderly people. Symptoms such as urine incontinence, gait dysfunction and cognitive impairment may be reversible with appropriate treatment. We herein describe a 55-year-old man with a partial obstructive hydrocephalus due to a pineocytoom compressing the aqueduct.

Pressure and argumentation in public controversiesDiscussants in a public controversy are also players in a social arena. Underwhat circumstances can means of exerting pressure promote reasonableoutcomes, and when are they rather hindrances to their achievement? Wediscuss the use of persuasion dialogues and negotiation dialogues by thosewho aim at a reasonable outcome. We show how in a public controversy bothtypes of dialogue can be intertwined. Then, we examine in what ways participants in a public controversy can exert pressure on others. Finally, we discusswhether these means of pressure hinder the achievement of a reasonableoutcome, both from the viewpoint of the pursuit of a resolution as well asfrom that of the pursuit of a compromise. We conclude that exerting pressureneed not degenerate into committing a fallacy of either the type argumentum ad baculum or the type argumentum ad carotam., Discussants in a public controversy are also players in a social arena. Under what circumstances can means of exerting pressure promote reasonable outcomes, and when are they rather hindrances to their achievement? We discuss the use of persuasion dialogues and negotiation dialogues by those who aim at a reasonable outcome. We show how in a public controversy both types of dialogue can be intertwined. Then, we examine in what ways participants in a public controversy can exert pressure on others. Finally, we discuss whether these means of pressure hinder the achievement of a reasonable outcome, both from the viewpoint of the pursuit of a resolution as well as from that of the pursuit of a compromise. We conclude that exerting pressure need not degenerate into committing a fallacy of either the type argumentum ad baculum or the type argumentum ad carotam.

Esophageal atresia is a rare congenital anomaly. Due to increased survival rates, the population of adults born with this malformation is growing. These patients turn out to have an increased risk to develop Barrett's esophagus, esophageal carcinoma or lung abnormalities like bronchiectasis. This is illustrated by three cases: a 42-year-old man with an irresectable esophageal squamous cell carcinoma; a 23-year-old man with a Barrett's esophagus without any reflux complaints; and a 51-year-old women with a reflux esophagitis and extensive bronchiectasis due to a combination of gastroesophageal reflux with chronic aspiration and a reduced sputum clearance because of a history of tracheomalacia. It is important for healthcare providers to be aware of these risks and the possible absence of symptoms, in order to detect abnormalities at an early stage and improve quality of life of these patients.

Esophageal atresia is a rare congenital anomaly. Due to increased survival rates, the population of adults born with this malformation is growing. These patients turn out to have an increased risk to develop Barrett's esophagus, esophageal carcinoma or lung abnormalities like bronchiectasis. This is illustrated by three cases: a 42-year-old man with an irresectable esophageal squamous cell carcinoma; a 23-year-old man with a Barrett's esophagus without any reflux complaints; and a 51-year-old women with a reflux esophagitis and extensive bronchiectasis due to a combination of gastroesophageal reflux with chronic aspiration and a reduced sputum clearance because of a history of tracheomalacia. It is important for healthcare providers to be aware of these risks and the possible absence of symptoms, in order to detect abnormalities at an early stage and improve quality of life of these patients.

Technological developments in ophthalmic imaging and artificial intelligence (AI) create new possibilities for diagnostics in eye care. AI has already been applied in ophthalmic diabetes care. AI-systems currently detect diabetic retinopathy in general practice with a high sensitivity and specificity. AI-systems for the screening, monitoring and treatment of age-related macular degeneration and glaucoma are promising and are still being developed. AI-algorithms, however, only perform tasks for which they have been specifically trained and highly depend on the data and reference-standard that were used to train the system in identifying a certain abnormality or disease. How the data and the gold standard were established and determined, influences the performance of the algorithm. Furthermore, interpretability of deep learning algorithms is still an ongoing issue. By highlighting on images the areas that were critical for the decision of the algorithm, users can gain more insight into how algorithms come to a particular result.

Exertional heat stroke (EHS) is a medical emergency characterized by life-threatening hyperthermia and central nerve system dysfunction during or directly after exercise. Early recognition and aggressive cooling reduces morbidity and mortality of patients with EHS. Therefore, all health care professionals involved in acute care should immediately recognise EHS and start cooling with cold water immersion as soon as possible. Most EHS occur in young and healthy individuals without a medical history, such as athletes or soldiers. We report the case of EHS in a 26-year-old man without a medical history. He suffered from EHS during a military admission test. A few years later he had a second EHS during military training. This time, the EHS was complicated by compartment syndrome, rhabdomyolysis, acute kidney injury and epilepsy. He fully recovered from both EHS episodes. Muscle histology, whole exome sequencing and heat tolerance tests did not show any abnormalities.

Openheid over psychische problemen kan het gemakkelijker maken om werk te vinden of te behouden, maar kan ook leiden tot verlies van werk of afwijzing bij solliciteren. In dit kwalitatieve focusgroeponderzoek werd onderzocht wat voor- en nadelen van openheid in de werkomgeving zijn, en welke factoren invloed hebben op een voor de werknemer- gunstige uitkomst. Focusgroepen bestonden uit: (1) mensen met psychische aandoeningen, (2) HR-managers, (3) werkgevers, (4) re-integratieprofessionals (waaronder bedrijfsartsen) en (5) ervaringsdeskundigen verbonden aan Samen sterk zonder Stigma. Over het algemeen vond men dat openheid belangrijke voordelen kan hebben, maar dat wanneer de gezondheidsklachten niet van invloed zijn op de werkzaamheden, het beter is om niets te zeggen, om stigma en discriminatie te voorkómen. Veel factoren bleken van invloed op de uitkomst, waarvan de werknemer of werkzoekende alleen invloed heeft op het openheidsproces zelf. Vooral belangrijk bleken: timing, selectieve openheid, inhoud van de boodschap, stijl van communiceren en voorbereiding.

We present a case of a woman who smoked cigarettes and who had a cervical lesion suspected to be a cervical carcinoma. Smoking increases the risk of Cervical Intraepethelial Neoplasia and cervical cancer twofold. Offering smoking cessation support should be offered to all smokers who present themselves.

Myocarditis, a treacherous condition It is important to recognize myocarditis at an early stage. To illustrate this, we present two male patients aged 39 and 51, respectively, who were admitted with febrile disease and signs of circulatory instability. Initially, myocarditis was not suspected in these patients. After the sudden death of the younger patient it was discovered that he had had fulminant myocarditis. Its nonspecific, heterogeneous clinical presentation, and potentially disastrous outcome make myocarditis a treacherous condition, which mainly affects younger adults. Although its aetiology is broad, the primary cause in the western world is a viral infection leading to lymphocytic myocarditis. Fulminant forms are rare, but this diagnosis needs to be considered in patients with an atypical illness and impaired haemodynamics or electrocardiogram (ECG) abnormalities. Early and liberal consultation of a cardiologist is important. Primary diagnostics include blood testing (e.g. troponin, creatinine kinase), ECG, echocardiography and exclusion of coronary ischaemia. The diagnosis can be confirmed by cardiovascular MRI or endomyocardial biopsy.

Chronic diarrhoea occurs in patients of all ages and is a very common reason for patient visits to a general practitioner or medical specialist. The differential diagnosis of chronic diarrhoea is extensive and identification of the underlying cause can be challenging. In this article we answer 12 topical questions concerning the management of chronic diarrhoea in practice.

Afgelopen jaren is depressiepreventie sterk ontwikkeld, zowel in onderzoek als in de praktijk, en het heeft laten zien dat er weldegelijk positieve effecten zijn voor zowel jongeren. Toekomstig onderzoek kan bijdragen aan de zoektocht naar mogelijkheden om de effectiviteit van preventieprogramma’s te vergroten en aan de uitdagingen die implementatie meebrengt

There is no such thing as a perfect diagnostic test and the value of a test depends on the situation in which the test is being used. Here, we discuss two options for dealing with the diagnostic process for Lyme borreliosis in general practice. One option is to manage, treat or refer according to clinical signs and symptoms, in accordance with Dutch practice guidelines. The other option is to use laboratory tests to guide further patient management (treatment or referral). The choice depends on currently unknown factors, such as the pre-test probability of Lyme disease in patients presenting to general practitioners. Furthermore, clarity is required about how to proceed after a positive or negative test result. The consequences of a false test result will depend on the patient's status, possible alternative diagnoses and treatment options. Both physician and patient should be aware of the shortcomings of diagnostic tests.

There is no such thing as a perfect diagnostic test and the value of a test depends on the situation in which the test is being used. Here, we discuss two options for dealing with the diagnostic process for Lyme borreliosis in general practice. One option is to manage, treat or refer according to clinical signs and symptoms, in accordance with Dutch practice guidelines. The other option is to use laboratory tests to guide further patient management (treatment or referral). The choice depends on currently unknown factors, such as the pre-test probability of Lyme disease in patients presenting to general practitioners. Furthermore, clarity is required about how to proceed after a positive or negative test result. The consequences of a false test result will depend on the patient's status, possible alternative diagnoses and treatment options. Both physician and patient should be aware of the shortcomings of diagnostic tests

Feedback in schrijfvaardigheidsonderwijs gaat over de kwaliteit van teksten en moet leerlingen helpen hun schrijfvaardigheid verder te ontwikkelen. Jochem Aben, Brenda van den Broek, Nina Vandermeulen, Elke van Steendam en Gert Rijlaarsdam ontwikkelden voor leerlingen in 4 en 5 vwo een feedbackrapport over hun schrijfproces, dat het schrijfgedrag van leerlingen in kaart brengt als zij op de computer een tekst schrijven op basis van bronnen. Het feedbackrapport beoogt gestuurde zelfstudie: de leerlingen worden via uitleg en toepassingsopdrachten vertrouwd gemaakt met hun schrijfprocesgegevens en aangezet tot analyse en verandering. Een test van het rapport in een kleinschalige studie wees uit dat het leerlingen inderdaad in staat stelt zelfstandig concrete acties te formuleren om hun schrijfproces te verbeteren.

Underwater birth is becoming increasingly popular because of the advantages for the mother. Women who deliver in this way feel less pain and therefore pain relief is less frequently needed during the delivery. But what seems to be forgotten is the fact that aspiration of water by the neonate could take place during an underwater birth, resulting in respiratory distress.A one-day-old neonate was admitted because of tachypnoea following underwater delivery at home. The respiratory rate of the neonate was one hundred breaths per minute without evident signs of dyspnoea. Chest radiography showed bilateral patches on the lungs consistent with aspiration of bathwater. After seven days of intravenous antibiotic treatment, the neonate recovered and could be discharged home.An underwater birth may cause respiratory problems in the neonate. If a pregnant woman wants to deliver under water, she should also be advised of the potential detrimental consequences for the neonate.

In many countries, neoadjuvant chemoradiotherapy (nCRT) plus surgery is standard treatment for resectable oesophageal cancer. After nCRT, up to 30% of all patients have no residual disease in the resection specimen. Consequently, an active surveillance approach, in which patients undergo frequent clinical investigations after nCRT instead of standard oesophagectomy, is increasingly applied in selected patients. Here, we describe outcomes for three patients who underwent active surveillance. A 63-year old woman was considered unfit for surgery after nCRT. Four years after completion of nCRT, she still had no signs of disease recurrence. The second patient, a 57-year old woman, refused surgery when no residual disease was detectable after nCRT. One year following treatment, she developed a vertebral metastasis, in the absence of locoregional disease. The third patient concerned a 66-year old man with a clinically complete response after nCRT, who also refused surgery. During active surveillance, he developed a locoregional regrowth and underwent a radical oesophagectomy.

Het syndroom van Korsakov is een ernstige neurocognitieve aandoening die optreedt ten gevolge van vitamine B1-tekort bij langdurig alcoholisme. Het huidige artikel geeft een overzicht van twaalf studies die zijn uitgevoerd naar neuropsychologische behandelingen bij het syndroom van Korsakov. We concluderen dat de basis voor het verbeteren van het functioneren van korsakovpatiënten ligt in het aanbrengen van een grote mate van voorspelbaarheid in het dagelijks leven. Foutloos leren is een leertechniek die hoopgevende resultaten laat zien voor het aanleren van vaardigheden en namen, maar nog niet systematisch onderzocht is voor deze patiëntengroep. Er zijn op dit moment nog maar enkele onderzoeken verricht naar compensatiemogelijkheden en holistische behandelprogramma's. Op basis van het huidige overzichtsartikel kan daarom geconcludeerd worden dat de neuropsychologische behandeling voor korsakovpatiënten nog in de kinderschoenen staat en het beschikbare onderzoek naar verbetermogelijkheden hoopgevende resultaten laat zien.

OBJECTIVES: Record review is the most used method to quantify patient safety. We systematically reviewed the reliability and validity of adverse event detection with record review.DESIGN: A systematic review of the literature.METHODS: We searched PubMed, EMBASE, CINAHL, PsycINFO and the Cochrane Library and from their inception through February 2015. We included all studies that aimed to describe the reliability and/or validity of record review. Two reviewers conducted data extraction. We pooled κ values (κ) and analysed the differences in subgroups according to number of reviewers, reviewer experience and training level, adjusted for the prevalence of adverse events.RESULTS: In 25 studies, the psychometric data of the Global Trigger Tool (GTT) and the Harvard Medical Practice Study (HMPS) were reported and 24 studies were included for statistical pooling. The inter-raterreliability of the GTT and HMPS showed a pooled κ of 0.65 and 0.55, respectively. The inter-rater agreement was statistically significantly higher when the group of reviewers within a study consisted of a maximum five reviewers. We found no studies reporting on the validity of the GTT and HMPS.CONCLUSIONS: The reliability of record review is moderate to substantial and improved when a small group of reviewers carried out record review. The validity of the record review method has never been evaluated, while clinical data registries, autopsy or direct observations of patient care are methods that can be used to test concurrent validity.

In deze studie (n = 121) werd terugkeer naar werk en werktevredenheid één jaar na het CVA in kaart gebracht. Daarnaast zijn mogelijk voorspellende factoren (CVA-gerelateerde en [neuro]psychologische variabelen gemeten twee maanden na het CVA) bepaald. De helft van de patiënten was in staat om volledig terug te keren naar het aantal werkuren van voor het CVA. Echter, 28% keerde niet terug naar werk. Van de fulltime werkenden (meer dan 35 uur per week) na het CVA was 90% tevreden met de werksituatie, terwijl dit 36% was bij de niet-werkende patiënten. Het cognitief functioneren en de depressieve klachten twee maanden na het CVA bleken geassocieerd met terugkeer naar werk één jaar na het CVA. Alleen het cognitief functioneren was een onafhankelijke voorspellende factor. Aangezien neuropsychologische factoren een belangrijke rol spelen in terugkeer naar werk dient hier aandacht aan besteed te worden tijdens de nazorgspreekuren en revalidatiebehandeling.

Study the association between the introduction of tobacco control policies in the Netherlands and changes in perinatal outcomes. National quasi-experimental study. We used Netherlands Perinatal Registry data (now called Perined) for the period 2000-2011. We studied whether the introduction of smoke-free legislation in workplaces plus a tobacco tax increase and mass media campaign in January 2004, and extension of the smoke-free law to the hospitality industry accompanied by another tax increase and media campaign in July 2008, was associated with changes in perinatal outcomes. We studied all singleton births (gestational age: 24+0 to 42+6 weeks). Our primary outcome measures were: perinatal mortality, preterm birth and being small-for-gestational-age (SGA). Interrupted time series logistic regression analyses were performed to investigate changes in these outcomes occurred after the introduction of the aforementioned tobacco control policies (ClinicalTrials.gov: NCT02189265). Among 2,069,695 singleton births, 13,027 (0.6%) perinatal deaths, 116,043 (5.6%) preterm live-births and 187,966 (9.1%) SGA live-births were observed. The policies introduced in January 2004 were not associated with significant changes in any of the primary outcome measures. A -4.4% (95% CI: -6.4 to -2.4; p < 0.001) decrease in odds of a SGA birth was observed after the policy extension in July 2008 to include a smoke-free hospitality industry, a further tax increase and another media campaign. This translates to an estimated over 500 cases of SGA being averted per year. A reduction in SGA births, but not preterm birth or perinatal mortality, was observed in the Netherlands after extension of the smoke-free workplace law to include bars and restaurants, in conjunction with a tax increase and media campaign in 2008

Neglect occurs in 30-50% of patients in the subacute phase post-stroke. Patients with neglect ignore one side of their body or one part of the space around them. - Treatment of neglect is important, as patients with neglect recover more slowly and are less independent compared to patients without neglect.- Visual scanning training is currently recommended in the guidelines as a treatment. The focus of this intensive treatment is on compensation, not on recovery. Scientific evidence for its effectiveness is scarce. - Other treatments, such as prism adaptation, limb activation training and brain stimulation are being investigated. However, the available evidence for their effectiveness is insufficient as yet. - In addition to neuropsychological tests, outcome measures at the level of functioning in daily life should be included in studies regarding the treatment of neglect.- New research is increasingly focusing on combining different treatments, which should ultimately be adapted for each patient individually.