[Practice guideline 'Urinary incontinence in women' from the Dutch College of General Practitioners]. / NHG-standaard 'Incontinentie voor urine bij vrouwen'.

- 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.

[Dutch guideline 'Post-mortem examination for attending doctors' ready at last]. / Richtlijn 'Lijkschouw voor behandelend artsen'.

- The central theme of the guideline 'Post-mortem examination for attending doctors' is that the primary aim of the post-mortem examination is not to ascertain death as such, but to investigate whether the person died of natural or unnatural causes.- The guideline gives indications for the content of the post-mortem in order to make this differentiation reliable.- Only in cases of natural death is the attending doctor permitted to fill in a death certificate. - In cases of possible unnatural death where a crime or an imputable act may have been committed, a municipal coroner should be called in. - Post-mortem should be carried out as quickly as possible after notification, with the exception of nocturnal deaths in nursing homes, or comparable care institutions, when this decease is expected.

[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.

[Summary of the practice guideline 'Sore throat' (second revision) from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Acute keelpijn' (tweede herziening) van het Nederlands Huisartsen Genootschap.

The second version of the practice guideline 'Sore throat' has been updated from the 1999 version. --Infections of the throat generally cure spontaneously within 7 days. In most cases the sore throat is caused by a virus. Group A beta-haemolytic streptococci (GABHS) are the most important bacterial cause ofa sore throat. --In diagnostics, the main focus is placed on evaluating how sick the patient is in general. --In adolescents who have had a sore throat for more than 7 days, the possibility of mononucleosis infectiosa should be borne in mind. This diagnosis can be verified by a test for IgM against Epstein-Barr-virus. --Additional investigations to detect GABHS are not recommended. --Prescribing antibiotics is only recommended for patients who have a severe throat infection or an increased risk of complications. Pheneticillin or phenoxymethylpenicillin remains first choice. --Referral for tonsillectomy should meet the following criteria: 5 or more episodes of sore throat per year or 3 or more episodes per year in the last 2 years.

[Summary of the practice guideline 'Urinary incontinence' (first revision) from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Incontinentie voor urine' (eerste herziening) van het Nederlands Huisartsen Genootschap.

Two years after revision of the practice guideline 'Urinary incontinence' from the Dutch College of General Practitioners, it is time for a summary of the most important changes. The use of a bladder diary is recommended. In primary care, a stress test does not provide more information than history taking. Routine urodynamic testing is not indicated for patients presenting to their general practitioner with urinary incontinence. Treatment of stress, urge and mixed incontinence can usually be commenced in primary care; pelvic floor exercises and bladder training are preferred. If bladder training is not effective for urge incontinence, anticholinergic drugs should be considered. The use of oral and vaginal oestrogens and flavoxate is no longer recommended.

[Summary of the practice guideline 'Viral hepatitis and other liver diseases' (second revision) from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Virushepatitis en andere leveraandoeningen' (tweede herziening) van het Nederlands Huisartsen Genootschap.

The revised Dutch College of General Practitioners' practice guideline 'Viral hepatitis and other liver diseases' offers advice in the diagnosis and management of viral hepatitis A, B and C and other liver diseases. The guideline is important for general practitioners as well as specialists in internal medicine and gastroenterology. The emphasis is on the management of chronic hepatitis B en C, because the prevalence of these diseases has increased in the Netherlands and, in addition, the treatment options for chronic hepatitis have improved. Consequently, timely recognition and adequate referral of patients with chronic hepatitis B or hepatitis C have become more important. However, many patients with a chronic liver disease have no symptoms. Therefore, the general practitioner should be aware that a patient visiting the practice with fatigue and malaise could have a liver disease if he or she belongs to a high-risk group or has had high-risk contacts. If the general practitioner repeatedly finds increased liver transaminase values during routine examination of asymptomatic patients, additional diagnostic tests should be performed. Further tests should focus on viral hepatitis as well as on non-alcoholic fatty liver disease and non-alcoholic steatohepatitis or, depending on the history-taking, liver damage due to excessive alcohol, medication or drug use.

[New version of the pathology practice guideline for cervical cytology: sharpened criteria for adequacy; expanded use of new techniques]. / Nieuwe versie van de pathologiepraktijkrichtlijn voor cervixcytologisch onderzoek: criteria voor adequaatheid aangescherpt; gebruik van nieuwe technieken verruimd.

The Dutch Pathology Association (NVVP) has modified the practice guideline for cervical cytology. The changes were made in consultation with the Dutch College ofGeneral Practitioners (NHG) and the Dutch Society for Obstetrics and Gynaecology (NVOG). The four most important changes are: (a) breastfeeding is no longer a contraindication for smear taking; (b) the rejection of smears, under certain conditions, if the cervix has not been visualised; the representativeness of a smear depends in part on the degree to which the requesting physician has verified that the smear was taken from the cervix; if the smear lacks endocervical cells, it must be considered inadequate if the requestor has not seen the cervix or designates the portio as abnormal; (c) the use of thin-layer cytology is accepted; (d) addition of the test for high-risk Human papilloma virus (hrHPV-test) may reduce the number of secondary repeat smears.

[Summary of the practice guideline 'The red eye' (first revision) of the Dutch College of General Practitioners (NHG)]. / Samenvatting van de standaard 'Het rode oog' (eerste herziening) van het Nederlands Huisartsen Genootschap.

The revised NHG-guideline 'The red eye' provides recommendations for the diagnosis and therapy in patients with a red eye. In the presence of pain, decreased visual acuity and photophobia (alarm symptoms) should be considered as sight threatening conditions. In most instances a red eye results from conjunctivitis. The complaint of (an) early morning glued eye(s) makes a bacterial origin of acute infectious conjunctivitis more likely. Itching and a history of infectious conjunctivitis make the probability of bacterial involvement less likely. The type of discharge does not help to adequately distinguish bacterial from viral conjunctivitis. Since an infectious conjunctivitis is a self-limiting condition, no treatment is necessary as a rule. Antibiotic treatment is only rational if conjunctivitis is (most probably) caused by bacteria. It has to be considered only if a patient suffers from much discomfort, if complaints do not begin to decline after 3 days and in patients with preexisting corneal defects. Because of widespread resistance to fusidic acid this should in principle not be prescribed for treatment of conjunctivitis; chloramphenicol is still the drug of choice. During revision of the guideline discussions concentrated on 2 aspects: the position of slit lamp biomicroscopy in general practice and giving a patient with keratoconjunctivitis photoelectrica the remainder of a 'minim' with anaesthetic eye drops. Regarding both topics it was decided not to change the recommendations of the former version of the guideline: the use of slit lamp biomicroscopy remains optional for general practitioners and it remains permitted to give the remainder of a 'minim' with anaesthetic eye drops to a patient with keratoconjunctivitis photoelectrica.

[Summary of the practice guideline 'Problematic alcohol consumption' (second revision) from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Problematisch alcoholgebruik' (tweede herziening) van het Nederlands Huisartsen Genootschap.

Compared with the former guideline, more attention is paid to the attitude of the general practitioner towards problem drinkers (about 200 problem drinkers in a standard practice of 2350 patients) and the combined use of alcohol and drugs among young people. The five-shot questionnaire has replaced the earlier 'cutdown, annoyed, guilty, eye-opener' (CAGE) test. Laboratory tests are of little value in the diagnosis. The general practitioner is given tools with which to motivate problem drinkers to change their behaviour. Medication is of minor importance.

[Summary of the practice guideline 'Diabetes mellitus type 2' (second revision) from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Diabetes mellitus type 2' (tweede herziening) van het Nederlands Huisartsen Genootschap.

The practice guideline 'Diabetes mellitus type 2' (second revision) addresses the diagnosis, treatment and management of adults with diabetes mellitus type 2 in general practice. The aim of management is the prevention and treatment of diabetes-related symptoms and complications such as cardiovascular disease, nephro-, retino- and neuropathy. The general practitioner gives the patient education and lifestyle advice and repeats this regularly. In addition, the general practitioner and the patient strive to achieve good glycaemic control. The agent of first choice in the medicinal treatment of all type 2 diabetic patients is metformin. This is continued even after the addition of a sulphonylurea derivative or insulin. This represents a change compared to the previous version of the practice guideline. The indications for thiazolidinediones are limited. To reduce the cardiovascular risk, it is advised to aim at a systolic blood pressure below 140 mmHg. It is also recommended that each patient be prescribed a statin, unless the patient belongs to a subgroup in which the indication for cholesterol lowering therapy is weak or the patient refuses it. Compared to the former guideline, more emphasis is placed on the prevention of nephropathy. The general practitioner is advised to calculate the creatinine clearance yearly and to test for relevant albuminuria in each patient with a life expectancy of 10 years or more. If microalbuminuria is present, the patient is prescribed an angiotensin converting enzyme (ACE) inhibitor, even if the blood pressure is not elevated. The detection of patients with a high risk of diabetic ulcer is also given more emphasis.

[Summary of the practice guideline 'Otits media with effusion' (second revision) from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Otitis media met effusie' (tweede herziening) van het Nederlands Huisartsen Genootschap.

Most children pass through a period of otitis media with effusion, which can be considered as a normal reaction of the body to viral or bacterial infections. The general practitioner provides education and advice regarding the favourable prognosis of the hearing loss and is alert to the detection of high-risk groups and an aberrant course. In most children with otitis media with effusion, the general practitioner can wait for the disease to take its natural course. Children with persistent otitis media with effusion whose development is retarded should be referred to an otorhinolaryngologist. The former screening for perceptive hearing loss in infants resulted in the detection of many children with otitis media with effusion. Children with abnormal results on the new form of neonatal auditory screening should preferably be referred to a centre for audiology.

[Use of alcohol during conception, pregnancy and lactation]. / Gebruik van alcohol bij conceptie, zwangerschap en lactatie.

Recently, the Dutch Health Council published a report on the risks of the use of alcohol during conception, pregnancy and lactation. Because the medical literature does not prove the safety of the use of small amounts of alcohol, the Health Council recommends using no alcohol whatsoever. One may wonder whether the advice of the Health Council is not too rigid. Since Karl Popper, it is evident that the truth of the hypothesis that the consumption of small amounts of alcohol is safe will never be verified. Because the medical literature also does not prove the harmfulness of the irregular use of small amounts of alcohol, it is not necessary to upset pregnant women who occasionally take an alcoholic beverage. It is preferable to use no alcohol; however, the rare consumption of a single glass does not seem to be harmful.

[Summary of the practice guideline 'Miscarriage' (second revision) from the Dutch College of General Practitioners (NHG)]. / Samenvatting van de standaard 'miskraam' (tweede herziening) van het nederlands huisartsen genootschap.

The NHG practice guideline 'Miscarriage' provides guidelines for the diagnosis and management of pregnant women with vaginal bleeding during the period up to and including the 16th week after the first day of the last menstruation. The guideline has been revised on the basis of the developments over the last few years. The most important modifications are: In case of an imminent miscarriage, more consideration than before is given to the patient's preference with regard to ultrasonography, expectant management and curettage. The GP should therefore discuss the advantages and disadvantages of these options with the patient. A midwife was involved in the formulation of the new guideline. Referral from a GP to a midwife for transvaginal ultrasonography is offered as one of the possibilities. The paragraph on 'information' has been expanded on the basis of the results of a patient focus group.