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Drug repurposing is often presented as a cost-effective strategy to accelerate the development of new therapies. The underlying rationale is that the safety, pharmacokinetics and pharmacodynamics, and mechanism of action of these drugs are already known, as preclinical research phases have been completed and clinical experience has already been gained. Although repurposing therefore appears to be an attractive approach for many diseases, initiatives often encounter various practical challenges. To address these challenges, a clear strategy should be developed in advance, taking into account (1) the thoughtful selection of a candidate drug, (2) efficient use of (existing) data, and (3) successful implementation of the drug in clinical practice, with early involvement of relevant stakeholders.
Menstrual disorders are among the most common complaints in general practice and have a significant impact on quality of life, work, and well-being, yet they often remain under-recognised. The general practitioner plays a key role in identification, diagnosis, and management. Distinguishing physiological variation from pathology is not always straightforward. Diagnostic work-up is based on history-taking, a menstrual calendar, ultrasound, and, where indicated, haemoglobin/ferritin and coagulation screening. First-line treatment includes hormonal contraception (combined oral contraceptive pill, progestogen-only preparations, hormonal intrauterine device), tranexamic acid, and NSAIDs. Referral to secondary care is warranted when medical treatment fails, when structural uterine abnormalities are suspected, or in cases of severe anaemia. In secondary care, both pharmacological and minimally invasive options are available.
This case concerns a 13-year-old girl with a dark discoloration on her neck for 1 year. The skin condition was clinically diagnosed as terra firma-forme dermatosis. Treatment consists of firmly wiping the affected skin with gauze soaked in 70% alcohol.
Assessing the safety and effectiveness of the early-onset sepsis (EOS) calculator compared with the categorical guideline in reducing empiric antibiotic treatment in newborns with suspected EOS. Open-label, cluster-randomised controlled trial in 10 Dutch hospitals, randomised 1:1 to the EOS calculator or the categorical guideline. 1830 newborns (gestational age ≥34 weeks, ≥1 EOS risk factor) were included. Non-inferiority was assessed using four predefined harm criteria (respiratory support, circulatory support, culture-proven EOS, referral to tertiary hospital). Superiority was assessed as reduction of empiric antibiotics <24 hours postpartum. At least one harm criterion was present in 7.0% (64/915) of the EOS calculator arm, compared to 14.6% (134/915) in the categorical guideline arm (relative risk 0.48; 95% CI 0.36-0.63). Antibiotics were started in 7.2% (66/915) versus 26.6% (243/915), respectively (absolute risk reduction: 19.0%, 95% CI 11.3-26.7). EOS calculator implementation safely reduces empiric antibiotic use in newborns.
An 80-year-old woman presented with inspiratory stridor after eating. Imaging revealed a decompensated esophagus. Endoscopy showed food retention and a narrowed lower esophageal sphincter. Achalasia, a rare motility disorder, was diagnosed and a botulinum toxin injection was administered. Treatment options include botox, pneumatic dilation, or surgery, the patient opted to await botox effects.
Sustainable healthcare is essential to reduce environmental impact without compromising patient safety. This study investigates whether minor perianal surgery can be safely performed under a non-sterile condition, aiming to reduce material use, costs, and CO2-emissions, and whether these findings can be incorporated into a widely supported surgical protocol. A retrospective cohort study was conducted among patients who underwent minor perianal surgery under sterile or non-sterile conditions. Primary outcomes were postoperative wound infections (POWIs) within 30 days, cost savings, and CO2-reduction. A literature review and a survey among surgeons regarding the treatment of perianal abscesses were also conducted. 263 patients were included. POWI rates did not differ significantly between the groups. A non-sterile approach can save at least €1925 per hospital annually and significantly reduce CO2 -emissions. Nearly all surgeons considered sterile conditions unnecessary for the treatment of perianal abscesses. Non-sterile conditions for perianal surgery are both cost-effective and more sustainable. Moreover, there is strong support for implementations of this change among surgeons.
Diabetes mellitus is a prevalent chronic condition with major impact on quality of life. Traditional treatment relied on insulin injections and self-monitoring, but advances in diabetes technology, such as continuous glucose monitoring (CGM), insulin pumps, and Hybrid Closed-Loop (HCL) systems, now provide new opportunities for optimizing glycemic control. HbA1c remains the established marker for long-term outcomes, though complementary use of Time in Range (TIR) offers more detailed insight into daily glucose variability. Clinical evidence shows that technologies such as CGM, HCL, and connected devices can reduce HbA1c, increase TIR, and lower the risk of severe hypoglycemia, while also improving quality of life and psychosocial outcomes. However, implementation must be tailored to individual patients, considering motivation, skills, and context. Future developments, including fully closed-loop systems, further highlight the need for clinicians to remain informed about rapidly evolving technologies and to critically assess their added value in daily practice.
Approximately two-thirds of children naturally fear medical procedures, with their subjective experience being more influential than the actual severity of the intervention. Procedural stress can lead to anticipatory anxiety, distrust, and post-traumatic stress symptoms, making effective management crucial. This article presents a comprehensive approach to pediatric procedural comfort care through the 7P model for trauma-free care. Key strategies include building trust through age-appropriate communication, using "helpful language" that redirects attention away from pain and anxiety, implementing distraction techniques, and ensuring adequate pain management through topical anesthetics and local anesthesia. Parents play a vital role as active partners in care. The 3R model (Regulate, Relate, Reason) provides a structured approach for managing highly anxious children. Implementing procedural comfort care requires specific competencies including child-centered communication and emotion regulation skills. Investment in team training and educational programs is essential for widespread implementation and preventing long-term medical trauma in pediatric patients.
To analyse the number of GP home visits from 2017-2023 in The Netherlands, and to investigate whether this trend differed according to age, sex, multimorbidity, and neighbourhood deprivation. An observational study that used data derived from Nivel Primary Care Database, containing routinely recorded data from approximately 500 Dutch GP practices. The number of home visits was calculated by age, sex, multimorbidity, and neighbourhood deprivation. A 32% overall decrease in home visits was observed, with the sharpest decline in 2020. Short visits dropped by 52%, while visits for intensive GP care, often related to end-of-life situations, increased by 12%. We report a continuing decline in the number of home visits by GPs, comparing 2023 with 2017. Home visits for intensive GP care, often for patients at the end of life, increased since 2017. GPs may be forced to make choices owing to increasing workload and evolving care demands.
Traditionally, osteoarthritis was considered a wear and tear process, but new insights indicate that it is a biologically and evolutionarily determined process, related to biological rather than chronological age. Articular cartilage contains chondrocytes that are stable under normal conditions. However, in osteoarthritis, some of these cells become hypertrophic, similar to what occurs during endochondral ossification in the growth plate. This leads to cartilage breakdown and consequently a cascade of processes, including inflammation and further destruction, finally leading to the symptoms of osteoarthritis and the burden on the patient. OA should be considered an age related condition with an evolutionary and biological basis rather than a wear and tear process. The concept of wear and tear leads to avoiding and fear of movement, while exercise is actually an effective treatment for osteoarthritis and comorbidities. Using joint wear and tear to communicate about osteoarthritis should be avoided.
School attendance is essential for children and adolescents and plays a vital role in their cognitive, social, physical, and mental health. Extensive school absenteeism is a risk factor for adverse health outcomes, both in the short and long term. The MASS intervention focuses on the early identification of school absenteeism following reports of illness-related absences by schools. Currently, a structural pathway for signalling school absenteeism from within curative healthcare is missing. As a physician, it is important to address school absenteeism when consulting with children or adolescents and their parents. Consider school attendance as a routine aspect of overall health, and be aware that psychosocial problems often underlie significant absenteeism. If concerns arise, actively collaborate with the youth health professional as part of an integrated care approach.
Personcentered care is essential for a futureproof healthcare system, yet its implementation lags behind due to a predominantly diseasecentered perspective. Traditional educational approaches appear insufficient to shift this mindset. Perspective change rarely results from information transfer alone; it arises through personal experience. Art brings this experiential dimension into medical education and fosters a different way of seeing care. It helps healthcare professionals deal with complexity, uncertainty, and recognize their own assumptions. In the Netherlands, several artbased initiatives exist within medical training, including Medical Education Empowered by Theater for shared decisionmaking (MEET SDM). MEET SDM is an experiential training designed to promote perspective change for learning shared decisionmaking. Through reflexive dialogue, theater- and improvisational exercises, participants experience that shared decisionmaking requires genuine attention to another's perspective, connection, and (non)verbal presence. Participants reported concrete personcentered behavioral changes in clinical encounters, positively influencing the doctor-patient relationship. Artbased education contributes to overcoming the disease-centered perspective and supports a different way of viewing oneself, one's professional role, and the patient.
Prostate cancer is a common diagnosis and is usually established by PSA-driven diagnostics. The disease is often asymptomatic and does not affect the patient's life expectancy. Prostate cancer may follow an aggressive course with substantial mortality. Curative treatment options include robot-assisted radical prostatectomy and radiotherapy, sometimes in combination with hormonal therapy. Although these treatments are effective, they may be associated with urinary incontinence, erectile dysfunction, and urinary and gastrointestinal symptoms. Hormonal therapy has a broad spectrum of side-effects. The treatment of metastatic disease consists of hormonal therapy, in combinations or sequentially, and chemotherapy. Mortality in metastatic prostate cancer is high.
A 53-year-old woman with Down syndrome presented with progressive palmar hyperkeratosis, erythema, and pruritus, accompanied by widespread papules and nodules. Considering a recent institutional outbreak of scabies and dermoscopic findings of multiple burrows and mites (delta sign), a diagnosis of crusted scabies was made. Treatment with ivermectin, permethrin, and strict hygiene measures resulted in resolution.
Umbilical granulomas are common in newborns. In The Netherlands, they are commonly treated with silver nitrate. Elsewhere, table salt (sodium chloride) is also used for this purpose. We investigated whether treatment with table salt is effective and feasible for parents. For this study, we approached parents of newborns with an umbilical granuloma. We demonstrated the treatment once and asked the parents to apply table salt to the granuloma twice daily for three days. We assessed the results 14 days after the start of the treatment. We asked parents about the results, side effects, their satisfaction, and whether they found the treatment feasible. Twenty-eight children participated in this study, and after fourteen days, the granuloma had disappeared in 25 (89%). In nine children (32%), the surrounding skin showed transient reddening. According to 24 parents (86%), the treatment was feasible, and 23 of them (82%) were satisfied with the results. Parental application of table salt is an appealing alternative to silver nitrate in the treatment of umbilical granuloma.
Pink-red discoloration in the diaper of neonates is often attributed to harmless urate crystals, formed from uric acid. However, clinicians should remain alert to other possible causes of pink-red discoloration. Here we present two cases of pink-red discoloration in neonates: one due to a congenital mesoblastic nephroma and the other one due to renal vein thrombosis as underlying cause. Additional diagnostics should be considered at a low threshold, starting with a simple urine dipstick. If the dipstick is negative for haem, hematuria can be excluded. If positive, urine sediment analysis is the next step to differentiate between hematuria, myoglobinuria or hemoglobinuria. In case of persisting haem-negative pink-red discoloration or in case of hematuria, myoglobinuria or hemoglobinuria consultation with a pediatrician is recommended, as further diagnostic evaluation is recommended.
The recently published Dutch guideline 'Non-obstetric perioperative care during pregnancy' provides recommendations for managing surgical procedures in pregnant patients. Despite limited evidence, key recommendations include favouring minimally invasive techniques, such as laparoscopy, due to reduced recovery time and complications. Laparoscopy is feasible in all trimesters, with considerations for uterine size and trocar placement. Neuraxial or regional anaesthesia is preferred over general anaesthesia when possible, as it improves postoperative pain control and reduces opioid use. Routine foetal monitoring is not recommended unless significant maternal hemodynamic fluctuations are expected. The timing of surgery should be carefully evaluated, with elective procedures preferably postponed unless medically necessary. A multidisciplinary approach involving surgeons, obstetricians, anaesthesiologists, and neonatologists is essential for optimizing maternal and foetal outcomes. Shared decision-making and thorough patient counselling remain crucial.
Early recognition and treatment of disturbed eating behavior is crucial. It can develop into a full-blown eating disorder through various mechanisms. Often this process can be interrupted at an early stage. Training of primary care professionals is essential for this because they often do not relate nonspecific physical or psychological symptoms to disturbed eating behavior. This often results in years of delay in diagnosis and initiation of counseling. This article provides diagnostic tools and practical guidelines for collaboration in primary care, based on a general practitioner as director, a specialized dietician and a mental health professional (the 'triad'). This can contribute to improved care, sometimes resulting in a scaling down of mental health referral. This relatively simple collaborative structure is not significantly different, nor does it have to take more time, than care provided by a general practitioner to other vulnerable patient groups.
In media and on platforms like LinkedIn, survey results are often presented as undeniable facts: "The numbers don't lie." However, these interpretations can be misleading, as many studies are influenced by methodological limitations. This article explores examples of medical surveys that have shaped public opinion and policy but are based on selective or incomplete data. For instance, claims about doctors considering career changes or the impact of disciplinary complaints are often overstated, leading to misguided policy decisions. Similarly, misinterpretations of ICT risks or burnout rates among medical professionals can drive unnecessary investments or exacerbate issues without addressing the root causes. These misinterpretations can distort the actual needs of the healthcare system, resulting in inefficient use of resources and worsening the work environment for healthcare professionals. It is crucial to always contextualize survey data and carefully consider its limitations to make informed, effective decisions that truly improve healthcare.
A patent foramen ovale (PFO) is present in approximately 25-30% of adults and is usually asymptomatic. However, under conditions of elevated right heart pressure, a PFO can enable right-to-left shunting, allowing venous thrombi to enter the arterial circulation: a mechanism known as paradoxical embolism. We present a case of a 51-year-old woman who developed dyspnea, abdominal pain and, a painful swollen leg. Imaging revealed a saddle pulmonary embolism, renal and splenic infarctions and occlusion of the right brachial artery. Echocardiography confirmed the presence of a PFO. Other common sites of paradoxical embolism include the brain, mesenteric circulation, and coronary arteries. In patients with venous thrombosis, clinicians should carefully assess for signs of concomitant arterial embolism: examine the abdomen, evaluate peripheral pulses in the limbs and perform a basic neurological examination. This case highlights the importance of thorough clinical evaluation to ensure timely recognition of this potentially serious condition.