RESUMO
- The Dutch College of General Practitioners practice guideline 'Suspicious skin lesions' provides recommendations for diagnosis, treatment and referral for the most common premalignant and malignant skin disorders.- The practice guideline includes a flowchart which starts by looking at the colour and surface of the skin lesion to direct the general practitioner to the most likely diagnosis.- In case of strong suspicion of squamous cell carcinoma, keratoacanthoma or melanoma and in case of basal cell carcinoma or Bowen's disease with high-risk characteristics, the general practitioner will refer the patient to a dermatologist.- The general practitioner will take into account the histopathological diagnosis in determining treatment and referral policy in case of other suspicious skin lesions. It will be obtained by means of punch biopsy or - in the case of naevi - diagnostic excision.- In case of suspicious skin lesions, the general practitioner will inspect the whole skin.- General practitioner and patient should determine a treatment plan together in case of actinic keratosis, histopathologically diagnosed basal cell carcinoma, and Bowen's disease. To this end, the practice guideline includes information on treatment options for general practitioners and dermatologists.
Assuntos
Medicina Geral/normas , Clínicos Gerais , Guias de Prática Clínica como Assunto , Dermatopatias/diagnóstico , Doença de Bowen , Carcinoma Basocelular , Carcinoma de Células Escamosas , Diagnóstico Diferencial , Clínicos Gerais/psicologia , Humanos , Dermatopatias/patologia , Dermatopatias/terapia , Neoplasias CutâneasRESUMO
- The Dutch College of General Practitioners' (NHG) practice guideline 'Urinary incontinence in women' provides guidelines for diagnosis and management of stress, urgency and mixed urinary incontinence in adult women.- General practitioners (GPs) should be alert to signals for urinary incontinence in women and offer active diagnosis and treatment if necessary.- Shared decision making is central in the guideline; the GP and the patient should discuss therapeutic options and decide on treatment policy in mutual consultation.- Women with stress urinary incontinence can choose between pelvic floor exercises or a pessary as initial treatment. Placing a midurethral sling (MUS) will be discussed if initial treatment is insufficiently effective or in the case of serious symptoms.- When bladder training is ineffective in urgency incontinence, the GP will discuss the pros and cons of adding an anticholinergic agent.- Exercise therapy can take place in the GPs practice or under supervision of a pelvic physical therapist.