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F S Boukes

Publications and source records attributed to F S Boukes.

10 recordsLinked to original sources
PubMed2004

[Tetanus prophylaxis in general practice].

In response to the report 'Immunisation against tetanus following injuries' from the Dutch Health Council, the Dutch College of General Practitioners, the National Coordinating Body for the Control of Infectious Diseases and The Netherlands Vaccine Institute have drawn up guidelines for tetanus prophylaxis in general practice. The number of situations in which the administration of tetanus immunoglobulin or tetanus vaccine is indicated is now considerably lower. Some of the unclear aspects of the report have been further worked out and translated into definite guidelines. The guidelines are not only useful for general practitioners but deserve to be followed by all doctors treating patients with injuries.

Family Practice↗
PubMed2004

[Summary of the practice guideline 'Hormonal contraception' (second revision) from the Dutch College of General Practitioners].

When choosing a method of contraception, a woman must consider the pros and cons of various methods together with her family physician. In this process, the doctor provides information on the advantages and disadvantages, while the woman decides. A sub-50 pill of the second-generation preparation is the oral contraceptive of choice. If the woman chooses a newly developed method of contraception, she must be carefully informed about the uncertainties with regard to reliability and safety. Oral contraceptives are absolutely contra-indicated in the following cases: a history of myocardial infarction, stroke (CVA), venous thromboembolism, a known coagulation-factor deficiency, breast or endometrial carcinoma or severe liver-function disorders. Non-hormonal methods of contraception are preferred in such a case. If there are two or more risk factors for cardiovascular disease, the doctor and the patient must consider the pros and cons of hormonal contraception. In this connection, stopping smoking is more effective than not using an oral contraceptive. A prescription for an oral contraceptive can be given without a physical examination, not even a measurement of the blood pressure; follow-up is only necessary in the case of side effects or questions. Progestagen-only contraceptives are absolutely contraindicated in the following cases: current venous thromboembolism, vaginal bleeding of unknown origin, progestagen-dependent tumours such as breast cancer, and severe liver function disorders.

Contraceptives, Oral, Hormonal↗
PubMed2004

[Summary of the practice guideline 'Dementia' (second revision) from the Dutch College of General Practitioners].

The general practitioner (GP) should be aware of clues pointing to dementia. The GP can establish the diagnosis himself or refer the patient for extended testing. The diagnosis of dementia focuses on memory impairment, other cognitive impairments and decreased functioning in daily life. For patients with dementia and their relatives, information and advice are more important than medication. The GP must take care aspects into consideration as well as the way patients' relatives cope with the dementia patient. The treatment and care of the patient with dementia and the relatives requires good coordination and collaboration with other health workers.

Activities of Daily Living↗
PubMed2002

[Summary of the standard "Vaginal bleeding" (first revision) of the Dutch College of General Practitioners].

In the first revised version of the Dutch College of General Practitioners' practice guideline 'Vaginal bleeding' a distinction is made between excessive (cyclical), irregular, breakthrough and postmenopausal bleeding. The diagnostic guidelines are aimed at identifying possible causes. However, in a considerable number of patients no underlying cause is found and the bleeding is assumed to be caused by hormonal fluctuations, for instance shortly after the menarche or premenopausal. Other causes can be: myomas, an intra-uterine device (IUD), medication, or endometrial carcinoma. Furthermore, lesions of the perineum, vulva or vagina, a pelvic inflammatory disease, Chlamydia infection, cervical carcinoma, imminent abortion or ectopic pregnancy also have to be excluded. In this practice guideline, the management guidelines are limited to the treatment of bleeding from the endometrium. In most cases bleeding caused by hormonal fluctuations is self-limiting. However, symptomatic treatment with progestogens or sub-50 oral contraceptives is possible. NSAIDs taken during the first three days of menstruation are the second-choice treatment in women with excessive bleeding. Tranexamic acid or a levonorgestrel-releasing IUD are other possibilities. Postmenopausal women with vaginal bleeding, first of all have to be examined by means of a cervical smear and transvaginal ultrasonography, to exclude an endometrial carcinoma. They can initially be reassured if the ultrasonography reveals an endometrial thickness of 4 mm or less. In the case of persistent or recurrent vaginal bleeding, they should still be referred to a gynaecologist.

Female↗
PubMed2002

[Summary of the Dutch College of General Practitioners practice guideline 'The menopause'].

In the Dutch College of General Practitioners' practice guideline 'The menopause', the menopause is viewed as a physiological phase of life with its associated discomforts, which sometimes require treatment. The GP should inform women with menopausal symptoms about the extent to which oestrogens can diminish vasomotor symptoms and about the benefits and risks of hormonal therapy on various organ systems. Oestrogens can be used when vasomotor symptoms cause serious limitations in daily life. First choice is a sequential combination of oestrogen and progestagen hormones, in which progestagens are given at least ten days per month. When urogenital complaints need to be treated, vaginally applied oestrogens can be prescribed. Depressive symptoms, fatigue, myalgia or arthralgia should not be treated with hormonal therapy. Nor are oestrogens recommended for the prevention of osteoporosis and cardiovascular diseases.

Estrogen Replacement Therapy↗
PubMed2002

[Summary of The Dutch College of General Practitioners' 'Irritable bowel syndrome' standard].

The diagnosis of 'irritable bowel syndrome' can usually already be established after history-taking and a limited physical examination, particularly if the symptoms have persisted for many years in the same form. Additional investigations are indicated in the case of diarrhoea which lasts longer than 2 weeks, especially if the patient is also severely unwell or has rectal bleeding; further investigations are also required if older patients experience the symptoms for the first time, if there is blood loss upon defecation, if unintentional weight loss occurs or if a mass is felt on the left side of the abdomen. Further investigations consist of a rectal examination, measurement of the sedimentation, haemoglobin concentration and leukocyte count, sigmoidoscopy and an X-ray of the colon. Treatment should aim to reduce unnecessary concern and avoidance behaviour, and to positively influence additional stress-inducing factors, nutrition and physical activity. Medication is not indicated except for laxatives if constipation plays an important role and if advice about nutrition and physical activity provide insufficient relief.

Colonic Diseases, Functional↗
PubMedDate not supplied

Withdrawing long-term diuretic therapy in the elderly: a study in general practice in The Netherlands.

BACKGROUND: About 20% of all men and women age 65 or older are on maintenance therapy with diuretics. Multiple drug use and side effects increase with age whereas a clear indication for long-term diuretic therapy is not always present. The aim of the present study was to assess whether in some patients long-term diuretic therapy could be withdrawn in general practice. METHODS: This study is a pilot-study for a large multicentered randomized controlled trial in general practice. In one general practice in The Netherlands, 15 diuretic-using patients were selected from a total population of 52. All had been using diuretics for more than six months, were not hypertensive, and did not show overt symptoms of heart failure. In these 15 patients, diuretic medication was withdrawn under careful medical monitoring conditions. RESULTS: After six months, six patients were still without diuretic therapy. Diuretic therapy had to be resumed in nine cases, because of congestive heart failure (one), hypertension (three), bronchial asthma (one), increased ankle edema (two) and subjective complaints (two). The withdrawal of diuretic therapy caused an increase in mean systolic blood pressure, heart failure score, body weight and ankle edema. CONCLUSIONS: Long-term maintenance diuretic therapy in patients age 65 or older in general practice may be successfully withdrawn in selected cases. Careful medical surveillance during and after withdrawal is warranted.

Aged↗