[Contraception: article for education and training]. / Anticonceptie.

Successful contraception is essential and the stable number of abortions illustrate the success of contraception policies in The Netherlands. This article considers relevant issues based on the latest NHG Contraception Standard. The patient takes centre stage in the selection of contraceptive and tailor made care is imperative. There are a number of alternative contraceptives each with their own functionality and merits. An important distinction is the use of hormones; the latter in view of the growing awareness of women of the alleged pros or cons of hormones. Important criteria for the choice of contraceptive methods are stage of life, reliability, ease of use, influence on the menstruation cycle, and foremost the personal preference of the woman in question. There are both absolute and relative contra-indications for a number of contraception methods as tabulated in the article.

[The NHG practice guideline 'Head injury']. / De NHG-standaard 'Hoofdtrauma'.

General practitioners frequently treat patients with head injuries. The Dutch College of General Practitioners' (NHG) practice guideline has been developed because the existing multidisciplinary guideline on head injury 'Treatment of patients with mild traumatic head/brain injury' ('Opvang patiënten met licht traumatisch hoofd/hersenletsel') is too defensive for use in primary care. The a priori probability of complications is lower in general practice than in secondary care, so selection and appraisal of risk factors for intracranial injury are different to those in the multidisciplinary guideline mentioned above. Risk factors for intracranial injury differ slightly for patients aged ≥ 16 years and for patients aged < 16 years. Use of anticoagulants--coumarin derivatives, direct oral anticoagulants, and low-molecular-weight heparin, but not thrombocyte aggregation inhibitors--is a reason for consultation with, or referral to, a specialist. Criteria for urgent referral are unconsciousness or diminished level of consciousness, focal neurological deficits, post-traumatic fits or seizures, basal skull fracture or suspicion of high-energy trauma. In the case of patients with no indication for referral, advising that the patient should be woken up at regular intervals could be included in the consultation provided written instructions were given.

[Summary of the Dutch College of General Practitioners' practice guideline 'Contraception']. / Samenvatting van de NHG-standaard 'Anticonceptie'.

The choice of a method of contraception is individual, based on factors including good advice from the general practitioner. There are various reliable forms of contraception available, such as the contraceptive pill, the copper or hormone-containing coil (intrauterine device), the vaginal ring, the contraceptive patch, the contraceptive injection, contraceptive implants, and male sterilization (vasectomy) or female sterilization. When choosing for a combined hormonal preparation the preference is for a pill containing levonorgestrel and ethinylestradiol 30 µg. Women aged ≥ 35 years who smoke and are not prepared to stop are advised against taking combined preparations. Only liver-enzyme inducing drugs have been proven to have relevant interaction with hormonal contraceptives; this has not been proven in the case of antibiotics. A transvaginal ultrasound is not necessary following an uncomplicated insertion of an intrauterine device.

Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review.

OBJECTIVE: To perform a systematic review evaluating the value of abdominal radiography, colonic transit time (CTT), and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children. STUDY DESIGN: Eligible studies were those assessing diagnostic accuracy of abdominal radiography, CTT, or rectal ultrasound scanning in children suspected for idiopathic constipation. Methodological quality of the included studies was assessed with the Quality Assessment of studies of Diagnostic Accuracy included in Systematic reviews checklist. RESULTS: One systematic review summarized 6 studies on abdominal radiography until 2004. The additional 9 studies evaluated abdominal radiography (n = 2), CTT (n = 3), and ultrasound scanning (n = 4). All studies except two used a case-control study design, which will lead to overestimation of test accuracy. Furthermore, none of the studies interpreted the results of the abdominal radiography, ultrasound scanning, or CTT without knowledge of the clinical diagnosis of constipation. The sensitivity of abdominal radiography, as studied in 6 studies, ranged from 80% (95% CI, 65-90) to 60% (95% CI, 46-72), and its specificity ranged from 99% (95% CI, 95-100) to 43% (95% CI, 18-71). Only one study presented test characteristics of CTT, and two studies presented test characteristics of ultrasonography. CONCLUSION: We found insufficient evidence for a diagnostic association between clinical symptoms of constipation and fecal loading on abdominal radiographs, CTT, and rectal diameter on ultrasound scanning in children.

[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.