ABSTRACT
- The revised guideline 'Treatment of tobacco addiction and smoking cessation support' offers health professionals a framework to provide evidence-based care to patients who smoke, which should aid in reducing smoking prevalence and smoke-related morbidity and mortality.- Four topics of the guideline have been revised: behavioural interventions, pharmacotherapy, e-health interventions and e-cigarettes. For the other topics, the recommendations from the 2009 version remain unaltered.- It is important that health professionals offer a made-to-measure smoking cessation advice and apply a fit-for-purpose smoking cessation intervention.- Nicotine replacement therapy remains the first-line pharmacotherapy intervention and is most effective when combined with behavioural intervention.- E-health interventions are particularly effective when they are personalised and of an interactive nature, and when text messaging is incorporated.- At present, e-cigarettes are not recommended as an aid to smoking cessation.
Subject(s)
Practice Guidelines as Topic , Smoking Cessation/methods , Humans , NetherlandsABSTRACT
- This review evaluates the safety and efficacy of, smoking cessation interventions.- Behavioural counselling is the cornerstone of smoking cessation programmes.- This counselling can be supplemented with written self-help materials, telephone counselling and e-health tailored to individual patient preferences.- Behavioural counselling may be combined with pharmacotherapy for increased effectiveness. First choice is a combination of a nicotine patch and a nicotine lozenge or chewing gum, mainly because of the favourable side-effect profile.- Furthermore, varenicline, bupropion and nortripyline are effective in smoking cessation; varenicline appears to be the most effective drug. These drugs have, however, more contraindications and potential side effects, which necessitates a correct diagnosis and more intensive monitoring.- The e-cigarette is not recommended as it seems to be equally efficacious as nicotine replacement therapy, but its potential side effects - such as normalising smoking - have not been sufficiently investigated.
Subject(s)
Nicotinic Agonists/administration & dosage , Smoking Cessation/methods , Cognitive Behavioral Therapy , Electronic Nicotine Delivery Systems , Humans , Smoking , VareniclineSubject(s)
Facial Paralysis/history , History, 18th Century , History, 19th Century , Humans , ScotlandABSTRACT
Bell's palsy is the eponym for idiopathic peripheral facial paralysis. It is named after Sir Charles Bell (1774-1842), who, in the first half of the nineteenth century, discovered the function of the facial nerve and attracted the attention of the medical world to facial paralysis. Our knowledge of this condition before Bell's landmark publications is very limited and is based on just a few documents. In 1804 and 1805, Evert Jan Thomassen à Thuessink (1762-1832) published what appears to be the first known extensive study on idiopathic peripheral facial paralysis. His description of this condition was quite accurate. He located several other early descriptions and concluded from this literature that, previously, the condition had usually been confused with other afflictions (such as 'spasmus cynicus', central facial paralysis and trigeminal neuralgia). According to Thomassen à Thuessink, idiopathic peripheral facial paralysis and trigeminal neuralgia were related, being different expressions of the same condition. Thomassen à Thuessink believed that idiopathic peripheral facial paralysis was caused by 'rheumatism' or exposure to cold. Many aetiological theories have since been proposed. Despite this, the cold hypothesis persists even today.
Subject(s)
Bell Palsy/history , Facial Paralysis/history , History, 18th Century , Humans , Netherlands , Terminology as TopicABSTRACT
The first experiments for bridging peripheral nerve gaps using nerve tubulation emerged in the 19th century. Because Gluck (1853-1942) is said to have performed the first animal experiment of nerve tubulation in 1880, it is interesting to explore the background and veracity of this claim. The original documents on nerve tubulation in the 19th century were studied. We conclude that the conduit that was initially used for nerve tubulation was derived from a resorbable decalcified bone tube developed for wound drainage by Neuber (1850-1932) in 1879. Gluck proposed the use of the bone tube as a guided conduit for regenerating nerves in 1881 but stated briefly that his experiments failed because of scar formation. Vanlair (1839-1914) documented the first successful application of nerve tubulation using a bone tube to bridge a 3 cm sciatic nerve defect in a dog in 1882.
Subject(s)
Bioprosthesis/history , Guided Tissue Regeneration/history , Neurosurgical Procedures/history , Animals , Drainage/history , Drainage/instrumentation , France , Germany , Guided Tissue Regeneration/instrumentation , History, 19th Century , History, 20th Century , Nerve Regeneration/physiology , Neurosurgical Procedures/instrumentation , Peripheral Nerve Injuries , Peripheral Nerves/physiopathology , Peripheral Nerves/surgery , RomaniaABSTRACT
OBJECTIVE: To compare The anatomy lesson of Dr Nicolaes Tulp by Rembrandt (1632) with the findings during dissection of the forearm of a cadaver. DESIGN: Descriptive. METHOD: The left forearm of a 41-year-old white male cadaver was dissected, photographs being taken at every stage of dissection. The anatomical structures in the original painting and during dissection were described and compared. At dissection, several structures were displaced in an attempt to reproduce the anatomical structures as shown in the painting. RESULTS: Dissection revealed four anatomical differences in comparison with Rembrandt's painting: (a) the muscle belly seen at the proximal ulnar side of the forearm in the painting was not seen on dissection; section of the insertion of the M. flexor carpi radialis and transposition of this muscle to the location of the muscle belly created the possibility of lifting up the M. flexor digitorum superficialis and reproducing the muscle belly; (b) in the painting, Tulp lifted only the M. flexor digitorum superficialis, but the amount of muscle tissue found in the forceps was increased in the painting compared with the dissection; (c) the positions of the bellies of the M. flexor digitorum superficialis to the index finger and 5th digit and to the 3rd and 4th digits were found to be reversed; (d) the longitudinal white structure situated in the ulnar part of the 5th digit in the painting was not found on dissection. This may have been an anatomical variant of the ulnar nerve. CONCLUSION: The anatomical characteristics of the painting could not be reproduced by dissection of the forearm of a cadaver.
