[Compliance of family physicians with the recommendations of 'Hearing Impairment' guideline by the Dutch College of General Practitioners in treatment of simulated paper cases of hearing loss]. / Overeenstemming tussen het handelen van de huisarts bij papieren casussen van slechthorendheid en de aanbevelingen in de standard 'Slechthorendheid' van het Nederlands Huisartsen Genootschap.

OBJECTIVE: To assess the extent to which the practice of general practitioners (GPs) in dealing with adult hearing-impaired patients complies with the recommendations in the NHG standard on 'Hardness of hearing', one year after its publication. DESIGN: Descriptive. METHOD: Eight paper cases concerning hearing-impaired patients were presented to 10 GPs. The compliance of the GPs' approach with the NHG standard was recorded, and the differences found were motivated by the GPs. RESULTS: Compliance was low for 'anamnesis' (27%), reasonable for 'supplementary examination'--'audiography' (42%) and 'whispered voice test' (12%)--and 'evaluation' (65%), and high for 'physical examination' ('otoscopy' 82%). Adapted questioning for the purpose of establishing the case history was observed. The questioning was adapted in so far as it took into account the information that had already been obtained. 'Management' gave high scores for 'instruction' (85%) and 'referral' (72%). For mostly practical reasons, the whispered voice test, recommended in the NHG standard was scarcely used (12%) whereas the tuning fork tests, which are not advocated in the NHG standard, were often used (43%). CONCLUSION: For the aspects 'otoscopy', 'instruction' and 'referral' the GPs' practice reflected the recommendations contained in the NHG standard 'Hardness of hearing'.

Phototoxicity and mutagenicity of 4,5'-dimethylangelicin and long-wave ultraviolet irradiation in Chinese hamster cells and human skin fibroblasts.

The phototoxicity and mutagenicity of 4,5'-dimethylangelicin (Ang) were assessed in cultures of hamster cells and human skin fibroblasts after long-wave ultraviolet irradiation. To obtain an impression of the clinical usefulness of Ang, we compared the phototoxicity and mutagenicity of this compound with those of 8-methoxypsoralen (8-MOP). To reach the same cell-killing rate in hamster cells and human skin fibroblasts, the concentration of Ang had to be 15 times higher than that of 8-MOP at comparable doses of radiation. Whether we used the same concentrations and an adjusted radiation dose or adjusted concentrations of Ang and 8-MOP at a constant radiation dose, the mutation induction in hamster cells and human skin fibroblasts was much higher after incubation with Ang than with 8-MOP.