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T J Wiersma

Publications and source records attributed to T J Wiersma.

At least 19 recordsLinked to original sources
PubMed2006

[Summary of the practice guideline 'Urinary-tract infections' (second revision) from the Dutch College of General Practitioners].

The 1999 practice guideline 'Urinary-tract infections' from the Dutch College of General Practitioners has been revised. Not only febrile urinary-tract infections are now regarded as 'complicated', but also all urinary-tract infections in men, pregnant women, children, and patients with kidney or urinary-tract disease, impaired immune response or an indwelling catheter. Under certain conditions, in women recognising the symptoms of an earlier uncomplicated urinary-tract infection, treatment may be instituted without performing supplementary urinalysis. The nitrite dipstick test and dipslide culturing are recommended for the diagnosis of urinary-tract infections; the value of the leukocyte esterase dipstick test is limited. A group-B streptococcal urinary-tract infection during pregnancy is an indication for intravenous antibiotic prophylaxis during the delivery. The recommended duration of treatment with nitrofurantoin is extended from three to five days. Both increased bacterial resistance to trimethoprim and the intention to reduce the use of fluoroquinolones in the treatment of uncomplicated urinary-tract infections were reasons for including phosphomycin in the guideline. In addition to antibiotic prophylaxis, cranberry products may be of value in the prevention of recurrent urinary-tract infections.

Anti-Bacterial Agents↗
PubMed2005

[Summary of the practice guideline 'CVA' from the Dutch College of General Practitioners].

The practice guideline 'CVA' from the Dutch College of General Practitioners provides guidelines for the management of stroke patients. The guideline is in agreement with the changing insights about the benefits of stroke-units and thrombolysis. The most important recommendations are the following. In the acute phase, most patients with a cerebrovascular accident should be referred for admission to a stroke-unit. Exceptions are patients with only slight neurological disability and patients with severe comorbidity. Patients with a CVA that started less than three hours ago should be referred for emergency thrombolytic therapy in regions where this possibility exists. In situations in which the general practitioner considers a home visit to involve an unacceptable loss of time, he may decide to refer on the basis of the results of the 'face-arm-speech-time' (FAST) test, which can be administered by telephone. For patients that remain at home, the general practitioner sees to the early start of a rehabilitation programme, and takes the initiative if necessary. The general practitioner can support stroke patients with permanent neurological deficits by considering them to be chronically ill patients requiring regular check-ups.

Emergency Medical Services↗
PubMed2005

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

The new practice guideline of the Dutch College of General Practitioners on the management of patients with a TIA resembles the first version, but there are some important changes: The concept TIA has been narrowed to a neurological deficit that has resolved spontaneously by the time the patient consults the doctor. The indications for referral of patients with a TIA in the area supplied by the carotid artery for investigation of a possible carotid stenosis and carotid surgery have been broadened. Auscultation of the internal carotid artery is no longer necessary. The daily amount of acetylsalicylic acid to be taken by a patient with a TIA has been increased from 30 mg to 80 mg. The prescription of dipyridamol following a TIA remains controversial.

Aspirin↗
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 'Pregnancy and puerperium' from the Dutch College of General Practitioners].

During the first trimester of pregnancy, obstetric care concentrates particularly on assessment of gestational age (by history taking or if menstrual history is unclear, ultrasonography) and on the assessment of obstetric or medical risk factors necessitating a referral for specialist care. Tracing hereditary conditions in relatives is important as this is a reason for antenatal screening for congenital abnormalities. In comparison to the previous guideline, blood testing in the first trimester has been extended to include screening for irregular erythrocyte antibodies and the possibility of screening for HIV. Pregnant women with a history of thyroid problems may also be tested for serum concentrations of thyroid stimulating hormone (TSH), free T4 and, on indication, the TSH-receptor antibody levels. Since haemodilution is physiologically normal during the second half of pregnancy, at a gestational age of 18 weeks and above, only a haemoglobin-level of 6.5 mmol/l or less justifies the diagnosis of anaemia, and should treatment be commenced. If a newborn does not show any abnormalities immediately after delivery, the physical examination now routinely carried out at a few days post-partum rarely produces any additional findings and can safely be omitted.

Family Practice↗
PubMed2001

[Unfounded recommendations for vitamin D supplementation in pregnant and breastfeeding women ].

In 2000, the Health Council of the Netherlands produced new dietary reference values for the intake of several vitamins, including vitamin D. These stated that pregnant and breast-feeding women without usual exposure to sunlight should consume at least 10 micrograms of vitamin D per day, while for women who were exposed to sunlight 7.5 micrograms daily would be sufficient. Because the mean intake through food is about 3 micrograms daily, the Health Council recommendations imply that all these women should take additional vitamin D. However, the recommendations are not evidence-based. Relevant clinical benefits of vitamin D supplementation in pregnant or breast-feeding women, such as increased bone mass and a reduced fracture risk for mother or child, have never been shown and, given the robust capacity of the skin to produce vitamin D under the influence of ultraviolet light, are rather improbable. Therefore, the intake of extra vitamin D by pregnant and breast-feeding women is unnecessary if they are regularly outside with at least their face and hands uncovered.

Female↗
PubMed2001

[Netherlands Health Council report:'Risks associated with folic acid fortification': those who don't risk, don't win].

Because the advice to take folic acid supplements is insufficiently followed by women who wish to become pregnant, a committee of the Health Council of the Netherlands investigated the possible risks associated with increasing folic acid intake through fortification of food products. The committee concludes that the risk of inducing or exacerbating neurological abnormalities by increasing the intake of folic acid in people with a vitamin B12 deficiency cannot be excluded. Therefore the fortification of food products should, for the time being, be limited to those foods which are especially aimed at women who wish to become pregnant. It is unlikely, however, that such a restricted food fortification program will lead to a decrease in the incidence of neural tube defects. Like the use of folic acid supplements, the purchase of special food products presupposes that the individual woman will undertake a positive action. Moreover, most women do not want their shopping to reveal their wish to have a child, and the need to cook their own meals will meet practical difficulties. The hypothetical and avoidable side-effects of food fortification have to be balanced against the certain benefit of preventing neural tube defects in unplanned pregnancies and pregnancies in women unaware of the benefits of folic acid supplementation. A revision of the report is recommended.

Adult↗
PubMed2001

[Guidelines for diagnosing urinary tract infections: advantages and disadvantages of various methods].

The revised guidelines on urinary tract infections from the Dutch Institute for Healthcare Improvement (CBO) and those from the Dutch College of General Practitioners (NHG), both published in 1999, differ concerning how these infections can best be diagnosed. In the case of a negative nitrite test result, the Institute advises to count the number of leucocytes or bacteria using a microscope, whilst the College advocates just counting the number of bacteria using a microscope or assessing bacterial growth by using a dip-slide. The difference may be explained by the diagnostic criterion for the numbers of colony forming units per millilitre of cultured urine. Leucocyturia with a typical history of acute dysuria and frequent voiding might indeed be sufficient as a diagnostic tool. However, it is questionable whether this is true in daily practice, where many patients with less typical complaints are encountered.

Colony Count, Microbial↗
PubMed2001

[Summary of the 'Urinary tract infections' guideline (first revision) of the Dutch College of General Practitioners].

The important changes in the Dutch College of General Practitioners' revised guideline on urinary tract infections, with respect to the first edition, are as follows: In assessing a urine sediment the leucocyte count has been omitted due to its low specificity. In the case of a negative nitrite test, the number of bacteria is of diagnostic importance. If a microscopic count is difficult to carry out, a semi-quantitative culture with a dip-slide is a good alternative. In the case of uncomplicated urinary tract infections, nitrofurantoin or trimethoprim are the preferred antibiotics, whereas for pregnant women nitrofurantoin and amoxicillin without clavulanic acid should be used. The most important pathogen is often resistant to sulphonamides. In the case of complicated urinary tract infections, characterised by fever, and a still unknown sensitivity of the pathogen, amoxicillin-clavulanic acid is recommended except in the case of pregnant women. The usefulness of tracing and treating pregnant women with asymptomatic bacteriuria has yet to be demonstrated.

Adult↗
PubMed2000

Molecular cytogenetic characterization of a small, familial supernumerary ring chromosome 7 associated with mental retardation and an abnormal phenotype.

A family is described in which a mother and two of her children were mosaic for a small supernumerary ring chromosome. As the origin of the ring chromosome could not be determined by routine cytogenetic studies, fluorescent in situ hybridization was performed, which indicated that the ring chromosome was derived from the pericentromeric region of chromosome 7. Further characterization with a YAC-probe showed the involvement of the proximal q-arm of chromosome 7. Both sibs had speech difficulties and were mildly mentally retarded whereas the mother's intelligence was at the lower end of the normal range. They all had an unusual face, characterized by a flat profile, short forehead, downslant of the palpebral fissures, high and broad nasal bridge, simply formed ears, and prognathia. This is the second report of a small supernumerary ring chromosome derived from the pericentromeric region of chromosome 7, and the described clinical phenotype differs from that delineated in the previous report.

Adult↗
PubMed1999

[Summary of the practice guideline 'Diabetes mellitus type 2' (first revision) of the Dutch College of General Practitioners].

The main changes of the first revision of the guideline of the Dutch College of General Practitioners on the diagnosis and treatment of diabetes mellitus type 2 compared with the first edition concern the following aspects: more attention is given to organisation and management of diabetes care; new diagnostic criteria for diabetes are introduced; guidelines are given for the early detection of diabetes in high risk groups; the distinction between sulfonylureas of the first and the second generation has been dropped; in the treatment of patients with diabetes and a body mass index > 27 metformin is the drug of first choice; optional guidelines are given for the treatment with insulin; guidelines are given for the treatment of hypertension and hypercholesterolaemia in patients with diabetes.

Diabetes Mellitus, Type 2↗
PubMed1999

[The 'Osteoporosis' guideline of the Dutch College of General Practitioners compared with the report by the Health Council].

Within one year the report 'Prevention of fractures related to osteoporosis' from the Dutch Health Council and the standard 'Osteoporosis' from the Dutch College of General Practitioners were published. At first sight the documents appear to diverge in several respects. The main discrepancy is that the standard shows far less optimism about the effects of drug therapy, by consequence of which only some well defined high risk groups should be treated. The standard therefore applies stricter criteria for case finding than the Health Council considers necessary. Although both documents base their opinions on similar studies and publications, they lead to different conclusions. Given the high prevalence of osteoporosis in the elderly part of the Dutch population, case finding seems to be a rather ineffective strategy for people at risk. Apparently, the Health Council at heart does not expect much benefit from drug interventions either. This forms an important indication that the remaining disagreements will be settled in the near future.

Aged↗