[Summary of the practice guideline 'Influenza and influenza vaccination' (first revision) from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Influenza en influenzavaccinatie' (eerste herziening) van het Nederlands Huisartsen Genootschap.

The first revision of the guideline 'Influenza and influenza vaccination' from the Dutch College of General Practitioners contains the new indications for influenza vaccination. The most important revisions are: the minimum age has been lowered from 65 to 60 years, the indication for furunculosis patients and their families has been removed, and vaccination is recommended to healthcare professionals who have regular and intensive contact with patients. The purpose of vaccinating healthcare professionals against influenza is to reduce the transmission of the influenza virus to patients at very high risk of complications from influenza and reduce sick leave among healthcare professionals. The use of antiviral agents should only be considered for patients with a very high risk of complications from influenza.

[Summary of the practice guideline 'Smoking cessation' from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Stoppen met roken' van het Nederlands Huisartsen Genootschap.

In general practice important health gain is obtainable by encouraging patients to stop smoking with support from the general practitioner. The practice guideline 'Smoking cessation' differentiates between smokers who are motivated to stop smoking, smokers who are considering smoking cessation, and smokers who are unmotivated to stop smoking. It is important to offer smokers, who are motivated to stop, intensive support at the right moment. Medicinal support in the way of nicotine replacement therapy, nortriptyline or bupropion is, ifpossible, recommended in motivated smokers who smoke at least 10 cigarettes daily.

[Outbreak of multi-resistant Escherichia coli on a surgical ward: course, measures and consequences for future admissions of contaminated patients]. / Multiresistente Escherichia coli-epidemie op een chirurgische afdeling: verloop, maatregelen en consequenties voor toekomstige opnamen van besmette patiënten.

In the period July-September 2003, a multi-resistant Escherichia coli strain caused an outbreak on a surgical ward in the Deventer Hospital, the Netherlands. This strain produced a beta-lactamase with an extended spectrum, making it resistant to third generation cephalosporins. Furthermore, the strain was resistant to trimethoprim-sulphamethoxazole (co-trimoxazole), gentamicin and quinolones, so that only treatment with carbapenems was possible. 8 patients were colonised. Genotyping of the strains by means of amplified fragment length polymorphism indicated the spread of a single strain. A multidisciplinary crisis team coordinated the infection control measures and the communication to involved persons and the press. Control measures consisted of contact isolation of colonised patients and extra attention to hand hygiene. After this proved to be ineffective, all patients on the ward were screened and the ward was closed for several days. The outbreak was stopped by strict cohorting ofthe colonised patients. There were no indications for transmission of resistance genes by plasmids. Several months later, on visiting the outpatient clinic, 3 other patients appeared to have been colonised by the epidemic E. coli strain during their admission. They had not been screened because they had already been discharged when all patients on the ward were screened for colonisation. In a follow-up study 9 months after the outbreak, 3 of the 6 investigated patients, who had in the meantime returned home, were still found to be colonised. Such patients constitute a risk for the re-introduction of multi-resistant bacteria into the hospital and should be preventively screened and isolated on admission.

[Acute low back pain: activity, NSAID's and muscle relaxants effective; bedrest and targeted exercise not effective; results of systematic reviews]. / Acute lage rugpijn: actief blijven, NSAID's en spierverslappers effectief, bedrust en specifieke oefeningen niet effectief; resultaten van systematische reviews.

OBJECTIVE: To inventory the current state of the art regarding the effectiveness of conservative treatment of acute low back pain. DESIGN: Systematic reviews. METHOD: The relevant literature from the period January 1966-September 1999 was retrieved via Medline, Embase, Psychlit and the Cochrane Library and via reference lists in the articles found. The methodological quality of the studies was assessed using criteria for internal validity. On the basis of the number of examinations, their quality and the consistency of the findings, conclusions were subdivided into four levels of strength of scientific evidence. RESULTS: Approximately two-thirds of the randomised trials in the field of back pain were of poor methodological quality. There was strong evidence that advice to stay active, non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants were effective in acute low back pain. There was also strong evidence that bed rest and specific exercises were not effective in acute low back pain. Strong evidence for effectiveness of many other commonly used interventions was lacking.

[Summary of 'Cholesterol' guideline (first revision) of the Dutch Society of Family Physicians]. / Samenvatting van de standaard 'cholesterol' (eerste herziening) van het Nederlands Huisartsen Genootschap.

The revised guidelines on cholesterol of the Dutch College of General Practitioners (DCGP), which closely follow the consensus of the Dutch Institute for Health Care Improvement, provide thresholds for treatment with statins in patients with elevated risks for coronary heart disease (CHD): patients with a history of cardiovascular disease, with an annual CHD risk larger than 2.5-3%, or with a (suspected) hereditary lipid disorder. Unlike the consensus the DCGP guideline advises only to determine a total cholesterol/HDL cholesterol ratio if the accompanying risk table indicates that the patient might fall in the range where drug treatment is indicated. For this purpose an extra column has been added to the table. In patients with a possible hereditary lipid disorder a higher threshold for referral to a specialist is used because moderately raised levels are common in the population and indicate a familial lipid disorder in only part of the cases.

[Summary of the updated guideline 'Gastric Complaints' of the Dutch College of General Practitioners]. / Samenvatting van de herziene standaard 'Maagklachten' van het Nederlands Huisartsen Genootschap.

The Dutch College of General Practitioners recently updated its guideline 'Gastric complaints'. The main change concerns Helicobacter pylori infection diagnosis and treatment. In cases of functional dyspepsia with Helicobacter infection antibiotic eradication treatment is not advised. In patients with gastric complaints, three working diagnoses are presented: aspecific gastric complaints, ulcer complaints, reflux complaints. Endoscopy is given a more prominent role than in the previous version of the guideline. Criteria are given for discontinuation of unmotivated long-term use of antacid medication.

[Back again: the clothes louse (Pediculus humanus var. corporis)]. / Terug van weggeweest: de kleerluis (Pediculus humanus var. corporis).

In two homeless men aged 38 and 32 years, who suffered from itching, infestation with body lice (Pediculus humanus var. corporis, a.k.a. clothes lice) was diagnosed. This infestation is rare in the Netherlands. In 1993 and 1994 and infection with body lice was registered 41 times in 31 patients at the clinic for homeless of the Community Health Service of Utrecht. The body louse can be seen by the naked eye. Treatment is by hygienic measures, pediculicides if necessary, and by prevention. Important to recognize is that P. humanus can be the vector of trench fever (Bartonella quintana), relapsing fever and typhus.