Pathogenesis and prevention of cardiovascular disease in patients with chronic kidney disease

Wee, P.M. ter [Promotor]Stehouwer, C.D.A. [Promotor]Smulders, Y.M. [Copromotor]Guldener, C. van [Copromotor

Acute hepatitis related to prednisolone

A 46-year-old woman, known to have multiple sclerosis (MS), presented with repeated episodes of elevated liver enzymes due to high-dose methylprednisolone therap

Diagnostische second opinion: wat levert het op? Patienten tevreden, diagnose zelden bijgesteld.

OBJECTIVE: To establish the yield of diagnostic second opinions in patients referred to a general internal medicine outpatient clinic at an academic hospital. DESIGN: Retrospective cohort study. METHODS: Of the patients newly referred to the general internal medicine outpatient clinic at the VU Medical Center, Amsterdam, the Netherlands during 2007, 86 were referred for a diagnostic second opinion. The diagnostic yield was assessed by comparing the outcome of the first and second opinions. To assess patient satisfaction, a telephone survey was held. RESULTS: There was a difference in diagnostic outcome between the first and the second opinions in 10 of the 86 patients included (12%). A significantly higher proportion of these patients was referred by a specialist, as compared to self-referrals or referrals by a general practitioner. The average satisfaction rate was high in all groups with a statistically significant difference in favour of the group with a different diagnostic outcome after the second opinion. The communication skills of the physician were the strongest determinant for overall satisfaction (r = 0.845; p <0.001). CONCLUSION: In an academic hospital second opinions for diagnostic purposes rarely yield a different diagnosis. Nonetheless, patients are usually satisfied with the process. During referral for a second opinion, care should be taken to avoid creating high expectations regarding a difference in diagnostic outcom

What have we here? A man or a fish?

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