The daily updated Dutch national database on COVID-19 epidemiology, vaccination and sewage surveillance.

The Dutch national open database on COVID-19 has been incrementally expanded since its start on 30 April 2020 and now includes datasets on symptoms, tests performed, individual-level positive cases and deaths, cases and deaths among vulnerable populations, settings of transmission, hospital and ICU admissions, SARS-CoV-2 variants, viral loads in sewage, vaccinations and the effective reproduction number. This data is collected by municipal health services, laboratories, hospitals, sewage treatment plants, vaccination providers and citizens and is cleaned, analysed and published, mostly daily, by the National Institute for Public Health and the Environment (RIVM) in the Netherlands, using automated scripts. Because these datasets cover the key aspects of the pandemic and are available at detailed geographical level, they are essential to gain a thorough understanding of the past and current COVID-19 epidemiology in the Netherlands. Future purposes of these datasets include country-level comparative analysis on the effect of non-pharmaceutical interventions against COVID-19 in different contexts, such as different cultural values or levels of socio-economic disparity, and studies on COVID-19 and weather factors.

Recruiting end-of-life cancer patients in the Netherlands for a study on suffering and euthanasia requests.

BACKGROUND: In the Netherlands, GPs performed euthanasia or physician-assisted suicide (EAS) in ∼1 of 10 end-of-life cancer patients in their care. Of all explicit requests for EAS directed at GPs, ∼44% resulted in EAS. However, the suffering of patients who do and do not request EAS has never been studied. An important barrier for such research is the low prevalence of end-of-life cancer patients per practice (on average two/year). We studied whether it is possible to recruit end-of-life cancer patients, following-up for requests for EAS (if any), in an interview study in general practice, whether selection occurred and which were the threats and opportunities to recruitment. Our target was to recruit at least 50 patients. METHODS: Characteristics of all eligible patients were monitored. RESULTS: One in every three eligible patients were recruited by 44 GPs in a 3-year inclusion period, resulting in 64 patients in the interview study with follow-up until death. The prevalence of explicit requests for EAS was higher (27%; P = 0.026) in the interview sample, and the presence of a depressed mood according to the GP was lower (5%; P = 0.013) than in the sample with eligible but not participating patients. CONCLUSIONS: Recruitment of slightly more than the minimal target number of end-of-life cancer patients in this study in general practice was realized. Monitoring of all eligible patients permitted to evaluate the selection which occurred. Recruitment through GPs who were direct professional colleagues of one of the researchers was a positive recruitment factor.

Old age is not a contra-indication for surgery in patients with primary hyperparathyroidism.

OBJECTIVE: Neck exploration for hyperparathyroidism is sometimes withheld from elderly patients out of concern for the risks. The question whether this concern is founded in fact was examined in a consecutive series of 18 patients aged 70 years or older who were operated for primary hyperparathyroidism in the period 1988-1993. The patients were referred by 6 institutions. RESULTS: Thirteen patients were considered symptomatic and 5 asymptomatic. The most common presenting symptoms were fatigue (n = 8), skeletal changes (n = 4), bone pain (n = 4) and polyuria (n = 4). Urolithiasis occurred in 2 patients. After operation with excision of all enlarged parathyroid glands serum calcium concentrations normalised in all patients. There was no mortality and the only complication was a late haematoma in a patient who used anticoagulants. The median postoperative hospital stay was 5 days (range 2-8 days). CONCLUSION: The high cure rate, the low morbidity, the low mortality and the short hospital stay favor neck exploration as the treatment of choice also in the elderly patient.

[Unnecessary localization studies in primary hyperparathyroidism]. / Onnodig lokaliserend onderzoek bij primaire hyperparathyreoïdie.

OBJECTIVE: To determine how often preoperative localisation tests are performed on patients suffering from primary hyperparathyroidism (pHPT) without previous neck surgery and to analyse the predictive value of such tests. DESIGN: Retrospective study. SETTING: University Hospital Utrecht, the Netherlands. METHODS: From 1988 to 1993 50 patients suffering from pHPT underwent initial surgical exploration of the neck. Clinical data, performed tests and results, findings at surgery, histological findings and clinical result were recorded. RESULTS: Localisation tests were performed 41 times on 27 patients (54%): 19 times ultrasonography, 14 times scintigraphy, 7 times computer tomography and once, venous sampling. Independent of preoperative testing, all patients underwent systematical, bilateral exploration of the neck. In 49 patients a total of 53 enlarged parathyroid glands were removed, all patients became normocalcaemic. Exploration revealed no abnormalities in 1 patient, who received no further surgical treatment. In 15 patients (56%) the localisation tests predicted the correct side of the enlarged glands, in 5 patients the wrong side was predicted and in 7 patients no prediction was possible. CONCLUSION: These results are in accordance with the poor predictive value of localisation tests prior to initial neck exploration as mentioned in other studies. The success rate of operation by an experienced parathyroid surgeon is 95-99 per cent. Preoperative localisation studies in patients with primary hyperparathyroidism without previous neck surgery are not only of poor predictive value, but should even be discouraged, because they may mislead the operating surgeon.

Treatment of localized non-Hodgkin's lymphomas of the head and neck.

BACKGROUND: Localized non-Hodgkin's lymphomas of the head and neck are generally treated with radiotherapy with or without chemotherapy, although the results of treatment of localized non-Hodgkin's lymphomas with of treatment of localized non-Hodgkin's lymphomas with chemotherapy alone appear to be favorable. It is unclear if and when combined modality therapy should be used. METHODS: The authors reviewed the records of 53 patients with Stage I or II non-Hodgkin's lymphoma of the head and neck, who were treated with radiotherapy alone (13 patients), chemotherapy according to the cyclophosphamide, doxorubicin, vincristine, prednisone- (CHOP) regimen (27 patients), or a combination of both treatments (13 patients). RESULTS: A complete remission was achieved in 43 (81%) patients. The 5-year survival for all patients was 78%. A significant difference (P = 0.03) in 5-year relapse-free survival was observed between Stages I and II disease, of 92 and 60%, respectively. Extensive tumor was a significantly poor prognostic factor (P = 0.04) with a 5-year relapse-free survival of 52 versus 84% for patients with nonextensive lymphoma. Eight relapses occurred; in five patients, a local relapse was the first presentation. Although salvage radiotherapy was successful in these five patients, a distant relapse developed in three. No relapses were observed in previously irradiated areas. CONCLUSIONS: Our results suggest that radiotherapy alone is the appropriate treatment for nonextensive Stage I intermediate grade non-Hodgkin's lymphoma of the head and neck. For extensive Stage I or II non-Hodgkin's lymphomas, chemotherapy is preferable. The value of combined modality therapy remains unclear.