The European TREatment of ATopic eczema (TREAT) Registry Taskforce survey: prescribing practices in Europe for phototherapy and systemic therapy in adult patients with moderate-to-severe atopic eczema.

BACKGROUND: For many years dermatologists have had access to few therapies for patients with moderate-to-severe atopic eczema (AE). New promising therapies are entering the market but conventional phototherapies and systemic therapies have more well-known safety profiles, lower costs and wider availability. OBJECTIVES: To provide insight into current prescribing practices of conventional phototherapy and systemic immunomodulatory therapies for adults with chronic AE, and the factors influencing these prescribing practices, before biologics and other novel therapeutics become routine clinical practice. METHODS: In this exploratory study dermatologists were invited to participate in an online survey via a mailing list of the European Academy of Dermatology and Venereology and national societies. Data were collected on participant characteristics (including clinical practice data), the use of phototherapies and systemic therapies, and factors influencing their use. RESULTS: From 30 European countries, 238 out of 361 dermatologists willing to participate (65·9%) completed the survey, with 229 meeting the inclusion criteria. For phototherapy (prescribed by 84·7%), most preferred narrowband ultraviolet B as first line (80·9%) and psoralen plus ultraviolet A as second (21·6%). For systemic therapy (prescribed by 95·2%) ciclosporin (54·1%), oral corticosteroids (32·6%) and methotrexate (30·7%) were used first line. Dermatologists relied mostly on personal experience for prescribing phototherapy and systemic therapy. Azathioprine and mycophenolic acid were prescribed by only 135 (59·0%) and 85 (37·1%) participants in total, mostly due to a lack of personal experience. CONCLUSIONS: This study provides insight into prescribing practices for conventional phototherapy and systemic therapy in Europe and shows that off-label therapies are also preferred as first-line choice of systemic therapy.

[National Health Services in the Netherlands: its influence on dental care]. / Ziekenfonds en tandheelkunde in de 20e eeuw. De tandheelkundige zorgverlening in het perspectief van de Nederlandse wet- en regelgeving.

In the year 1941 the National Health Services Act came into force in which the insured patients have claims to dentistry. The influence on dental care is beyond any doubt and is illustrated by some examples. The dental care for the youth is mentioned in particular. Special attention is paid to legal regulations concerning the application of fluorides.

[Integrated (biopsychosocial) treatment in the family practice: a pregnant patient with a sacral tumor and severe posttraumatic stress disorder]. / Integrale (biopsychosociale) behandeling in de praktijk: een zwangere patiënte met een sacrumtumor en een ernstige posttraumatische stressstoornis.

In a 25-year-old woman pregnant for the second time after a successful first pregnancy, a locally aggressive, invasive sacrum tumour was diagnosed. The execution of the necessary but potentially mutilating surgical procedures was seriously hampered even during the preparative phase, in spite of the conscious wish of the patient to comply, by her severe psychiatric problems (posttraumatic stress disorder with dissociative symptoms). The Psychiatric Consultation Service took over the case management and an integrated (biopsychosocial) diagnostic investigation was carried out, involving analysis of the problems on four system levels: the biological, the psychological, the social and the health care level. An integrated treatment plan was drafted. By collaboration of the entire multidisciplinary treatment team conditions were secured under which patient would let herself be treated. In this way she was enabled to undergo the necessary procedures, with good results.

A controlled trial of senna preparations and other laxatives used for bowel cleansing prior to radiological examination.

Film quality of PP, X-P and HP methods shows only small differences. 1-day preparation reduces the burden on nursing staff. The standardized sennoside preparations have a good palatability. HP was significantly better than X-P and is safe in diabetic patients. PP gives fewer side effects (cramps) than HP and X-P. Low residue dietary measures are essential for a good result.