Notes

Flexible Recruitments of Simple Muscle tissue Synergies inside the Start and minimize Arms and legs with regard to Very Varied Actions and also Poses.
The Psychiatric Hospitals (Compulsory Admissions) Act, Wet BOPZ in Dutch, will be replaced by two new laws as of 1 January 2020. This has many implications for patients as well as the physicians treating them. The new laws are emphasising treatment rather than admission. They also provide for more forms of treatment at home. However, there are several practical and fundamental sticking points and issues of coordination between the two laws.The ARRIVE trial has shown that elective induction of labour at 39 weeks improves maternal and foetal outcomes in comparison with expectant management. Caesarean sections, hypertensive disorders and neonatal ventilator support were all found to be reduced after elective induction. The trial was performed in an American nulliparous low-risk population. Several American professional organizations have now adapted their recommendation on elective induction in nulliparous low-risk women. These organizations now suggest informing women about the potential benefits, and offer elective induction in a model of shared decision-making. In the Netherlands there has been some reluctance amongst professionals to address this issue. This might be related to a conservative obstetric approach and the Dutch obstetric model with its three separate levels of care. #link# Nevertheless, this subject should be addressed in a scientific, professional and unprejudiced way, given the evidence and potential implications for the large group of low-risk women and neonates in the Netherlands.In 2012 the multidisciplinary guideline Q fever fatigue syndrome was developed for the Netherlands. The availability of new research data and developments and experiences from daily clinical practice made it necessary to revise this guideline. The multidisciplinary working group that has revised the guideline is composed of representatives from all medical professions involved in the care of patients with QFS and representatives of the patients' association. The revised guideline incorporates a number of changes, including refinement of the QFS diagnostic criteria and updates regarding advice on support and reintegration.Rudolf Virchow regarded medical education that did not include the history of medicine as barbarism. Despite this view, current education on medical history in medical faculties in the Netherlands is minimal in terms of the number of teaching staff and the hours spent on the subject. Important arguments for teaching medical history to medical students are academic development, a better understanding of the historic fundamentals of research, clinical practice and the medical profession and, more recently, a better understanding of the historical and social context of medicine. Modern education on the history of medicine provides a perfect opportunity for critical reflection on the complexity of modern-day medicine. On the basis of these arguments, history of medicine belongs within the framework for Undergraduate Medical Education as an independent domain with appropriate assessment.Surgical perfection takes years of training and a learning curve to optimize outcomes. This creates an ethical dilemma although healthcare systems benefit from training new surgeons, the learning curve may cause suboptimal outcomes for the first patients a resident operates on. Can collective interest for the betterment of healthcare be combined with the wellbeing of the individual patient? We argue that this is possible under controlled circumstances. Residency programmes can optimize the learning curve of the trainee by active and extensive supervision the 'See one, do one' mentality is outdated, even in relatively simple procedures. Residents can improve their skills by using hands-on training on animals or cadavers, or by re-watching their own procedures. It is possible that despite all preventative measures, the effect of the learning curve on surgical outcomes is inevitable and necessary where new surgeons are trained within regular healthcare systems. Ultimately, practice makes perfect.Various studies suggest that evening dosing of antihypertensive drugs may be more effective. In line, a randomized open-label trial in 19,084 hypertensive patients recently demonstrated that evening dosing of at least one antihypertensive drug resulted in a 3.3 mmHg lower systolic night-time blood pressure and 1.3 mmHg lower systolic 48-hour blood pressure when compared to morning dosing. Cardiovascular outcomes were reduced by 45% in the evening dosing group, which is remarkable as previous meta-analyses have shown that a systolic blood pressure reduction of 3 mmHg is associated with a 7% reduction in cardiovascular outcome. Although selleck inhibitor may be partly explained by specific beneficial effects related to evening dosing, it is likely that the open-label trial design may have affected the study outcome in different ways. Also, the safety of evening dosing in elderly hypertensive patients and the consequences for therapy compliance in the clinical setting remain to be established.The impact of genital warts on psychological, social and sexual wellbeing is often overlooked, as is the magnitude of the problem. In 2017, the number of consultations in primary care in the Netherlands was 42,000. Real-world evidence shows compelling and impressive results regarding the reduction of genital warts in other countries. Not opting for a vaccine that also protects against genital warts is a missed opportunity for elimination of cervical cancer as well as genital warts.The results of a recent randomised phase 3 clinical trial show that the androgen receptor antagonist darolutamide improves metastasis-free survival in men with non-metastatic, castration-resistant prostate cancer, compared with placebo. The trial included 1509 men with a prostate-specific antigen doubling time of 10 months or less. Non-metastatic disease was defined as the absence of metastases, using conventional imaging rather than the substantially more sensitive PSMA scans. The effect of darolutamide is similar to that of other androgen inhibitors, such as apalutamide and enzalutamide. The value of the current trial to Dutch clinical practice is limited, as the number of patients with non-metastatic, castration-resistant prostate cancer is low due to the increased use of PSMA scans and the reluctance of urologists to start androgen-deprivation therapy in the absence of metastatic disease.
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