ABSTRACT
The Dutch College of General Practitioners (NHG) recently published the practice guideline 'Lumbosacral radicular syndrome'. This guideline provides general practitioners with guidance for the diagnostic workup and treatment of patients with lumbosacral radicular syndrome. In this article we discuss the most important changes and modifications to this guideline point by point. The most important recommendations for management are summarized in a flowchart.
Subject(s)
General Practice/standards , Practice Guidelines as Topic , Practice Patterns, Physicians' , Radiculopathy/diagnosis , Radiculopathy/therapy , Disease Management , Humans , Lumbosacral Region , Netherlands , Pain Management/methods , Treatment OutcomeABSTRACT
The Dutch College of General Practitioners (NHG) guideline 'Stroke' covers the diagnosis, management and long-term care of stroke in general practice. Patients with neurological symptoms suspected to be due to cerebral infarction or haemorrhage should be transferred directly to a stroke unit. The specialized care provided by these units, including emergency interventions (e.g. intravenous thrombolysis) and early mobilization help improve outcomes. If neurological symptoms have resolved completely, the patient should be referred to a TIA service as soon as possible, preferably within 1 day. Stroke often leads to permanent disability and neuropsychological impairments. The general practitioner (GP) should provide patients and caregivers with information and support, and should be alert to the psychological consequences of stroke, both in patients and caregivers. Secondary prevention measures are started as soon as the diagnosis of stroke is confirmed. GPs should regularly evaluate and monitor risk factors and compliance.
Subject(s)
General Practitioners/standards , Practice Patterns, Physicians' , Stroke/diagnosis , Stroke/therapy , General Practice , Humans , Long-Term Care , Practice Guidelines as Topic , Societies, MedicalABSTRACT
A 56-year-old woman presented with acute right-sided hearing loss. At first presentation she was diagnosed as having otitis media with effusion. No tuning fork test was performed. After four weeks she was finally correctly diagnosed as having a right-sided sensorineural hearing loss of 90 dB. As a result of the delay no treatment was started. Her hearing loss did not show any improvement after three months. Sensorineural hearing loss is a rare, potentially invalidating condition with a considerable psychological impact. The treatment consists of systemic steroids, which may only be useful if started within 14 days after symptoms start. Some patients are initially treated for conductive hearing loss. Routine performance of the tuning fork test helps in differentiating between conductive and perceptive hearing loss. In cases of acute perceptive hearing loss, patients should be referred to the otorhinolaryngologist to exclude possible causes and start treatment and guidance.
