[The ICD in the terminal stage]. / De ICD in de terminale fase.

ICDs are used to prevent sudden death caused by ventricular fibrillation. The number of patients with an ICD will keep growing. ICD shocks can severely disturb the dying process in terminally ill patients. Patients must be informed about this at the time of ICD implantation. The attending physician is responsible for proactive communication regarding deactivation when death is expected imminently. The decision to deactivate the ICD depends on personal wishes, and has proved to be difficult even if the patient has been well informed. Deactivation at home must be available so that severely ill patients do not need to travel to a hospital.

[A newborn with a tumour on the tongue and alveolar ridge]. / Een pasgeborene met een afwijking op de tong en kaak.

In a newborn boy, a tumour was seen on the tongue and mandibula. A diagnosis of congenital epulis was made. This usually pedunculated tumour is present at birth and located on the maxillary or mandibular alveolar ridge (more commonly on the maxilla), but rarely on the tongue. It varies greatly in size from just a few millimetres in diameter to several centimetres. Treatment is only necessary when feeding problems occur.

[Summary of the Dutch College of General Practitioners' practice guideline on food hypersensitivity]. / Samenvatting van de NHG-Standaard 'Voedselovergevoeligheid'

October 2010 the Dutch College of General Practitioners issued a revised version of their previous practice guideline of 1995 on food hypersensitivity in infants. If patients suspect either themselves or their child of having a food allergy, this is usually not demonstrated in subsequent investigation. Wrongly prescribed elimination diets may have adverse effects. Examination of serum specific IgE levels has no place in the diagnosis of food allergy in general practice. An open elimination challenge is especially suitable in order to exclude a food allergy. A sure diagnosis of food allergy can only be made by a double-blind placebo-controlled food challenge. There are no proven effective measures that can prevent food allergy.

[Summary of the Dutch College of General Practitioners' practice guidelines on obesity]. / Samenvatting van de standaard 'Obesitas' van het Nederlands Huisartsen Genootschap.

Adults with obesity have a decreased life expectancy and an increased risk of disease. Preferred treatment is a combination of lifestyle interventions, consisting of changes in diet, physical exercise and psychological support. Normal weight is not an achievable target in most adults, but even a 5-10% weight loss yields significant health gains. Obese children run a significant risk of mental and physical illness and often become obese adults. Indeed, the practice guidelines recommend an active approach by the general practitioner if a child appears obese at a consultation, irrespective of the reason for consultation.

[Summary of the practice guideline 'The intrauterine device' from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Het spiraaltje' van het Nederlands Huisartsen Genootschap.

The practice guideline 'The intrauterine device' from the Dutch College of General Practitioners, first published in 2000, has been revised. Copper and hormonal IUDs have more or less the same level of reliability with respect to preventing pregnancy. During the use of a copper IUD, menstruation tends to be longer with a greater loss of blood; in 70% of women who use a hormonal IUD oligomenorrhea or even amenorrhoea develops. Women with a history of venous thromboembolism can use a hormonal IUD safely. In the first weeks after IUD insertion, there is an increased risk of pelvic inflammatory disease (PID). Therefore prior to insertion, the general practitioner should enquire about the risk of a SOA being present and, if necessary, perform SOA tests. In the Netherlands, IUD insertion can usually be performed at a general practice.

[Summary of Dutch College of General Practitioners guidelines on "Rectal bleeding"]. / Samenvatting van de standaard 'Rectaal bloedverlies' van het Nederlands Huisartsen Genootschap.

Rectal bleeding is often caused by a harmless disorder such as haemorrhoids or an anal fissure, but may be a symptom of colorectal cancer or inflammatory bowel disease. Risk factors for colorectal cancer are: older age (arbitrary > 50 years), a first-degree relative aged < 70 years with colorectal cancer, change in bowel habit, blood mixed with stools and the absence of anal or perianal symptoms. Colonoscopy should be performed when colorectal cancer is suspected. Treatment of haemorrhoids and anal fissures by the general practitioner especially includes education, treatment of comorbidity and, if necessary, local treatment. Proctoscopy is feasible in general practice.

[Summary of the practice guideline 'Prevention and early diagnosis of cervical cancer' of the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Preventie en vroegdiagnostiek van cervixcarcinoom' van het Nederlands Huisartsen Genootschap.

A persistent infection with human papillomavirus (HPV) underlies all cases of cervical cancer. HPV testing is repeated 6 months after initial Pap smears 2 or 3a1. As vaccination against HPV is now included in the National Immunisation Programme of the Netherlands, yearly cervical cancer morbidity and mortality rates are expected to be cut by half. After vaccination against HPV, women still need to participate in the cervical cancer screening programme. Breastfeeding is no longer a contraindication for making Pap smears, provided that breastfeeding is indicated on the cytology application form. Liquid-based cervical cytology is an equivalent to conventional cervical cytology and offers the possibility of testing for HPV. General practitioners are responsible for communicating results from the cervical cancer screening programme to the participating women.