By Joost Blijham
ISBN-10: 9031388254
ISBN-13: 9789031388257
ISBN-10: 9031388726
ISBN-13: 9789031388721
Ruim 20 jaar geleden is de eerste standaard van het Nederlands Huisartsen Genootschap (NHG) uitgekomen. Daarmee is het richtlijnenproject van het NHG wereldwijd een van de langst lopende en meest succesvolle programma’s voor proof dependent richtlijnenontwikkeling. In de loop van de jaren is de kwaliteit van de standaarden toegenomen. Belangrijke mijlpalen waren de keus voor een scheiding tussen aanbevelingen en onderbouwing met een notenapparaat commence jaren negentig en voor de toepassing van systematische literatuursearches op foundation van uitgangsvragen rond de eeuwwisseling. Door de levensduur van het richtlijnenproject en de vlotte introductie van standaarden als onderwijsmateriaal in de (huis)artsenopleiding, is inmiddels een groot deel van de zittende huisartsenpopulatie in Nederland opgegroeid met de standaarden. De meest huisartsen in Nederland gebruiken de standaarden in de dagelijkse praktijk als leidraad. Over 10 jaar zal het aantal huisartsen in Nederland dat niet met de standaarden is opgeleid, op de vingers van een hand zijn te tellen.Vanwege het grote belang van de NHG-Standaarden voor de huisartsengeneeskunde en de kwaliteit daarvan heeft het NHG gemeend de starten met het vertalen van standaarden in het Engels. Daarmee komen de in Nederland geldende facts dependent richtlijnen ter beschikking van doelgroepen buiten Nederland. Als pilot is begonnen met het vertalen van een tweetal standaarden te weten: M09 – Otitis Media Acuta en M29 – Kinderen met Koorts.Afhankelijk van de ontvangst zal worden besloten uit het totale aanbod van circa ninety NHG-Standaarden meer standaarden te vertalen.
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Extra info for NHG Clinical Practice Guidelines: M09 Acute Otitis Media (AOM) M29 Feverish Illness in Children
Example text
In newborns and infants, the classic symptoms of a urinary tract infection are often lacking [Van Wijk 1998]. Additional urine testing is therefore recommended in high-risk groups. Three different studies identified comparable risk factors, and none were performed in a primary care setting. 5 °C, young age (< 12 months old), uncircumcised males, fever without a focus, supra-pubic discomfort during medical examination and fever higher than 39 °C were found to be independent risk factors [Shaw 1998].
Distinction is made between observations by parents A and assessment by the GP. The parents/caregivers need to watch out for alarm symptoms; the GP assesses whether there are warning symptoms that can be objectified. Information about the child’s past medical history is requested during telephone triage. In children under the age of 2 with fever without apparent source, after history-taking and physical examination, urine testing should now be performed on the same day. In cases of fever without apparent source, reappraisal is recommended within 24 to 48 hours.
Craig 2000]. Ear thermometer: In a meta-analysis of 44 studies (n=4,441 children aged 0 to 16 years), large differences were found between the rectal thermometer and the ear thermometer. The differences were not correlated with temperature or child age. It cannot be ruled out that the presence of acute otitis media influenced the correlation, as the involved studies did not supply sufficient data on this subject. Measured temperatures deviated in both directions. 29 °C [Craig 2002]. 9) compared to a rectally measured temperature of > 38 °C.
NHG Clinical Practice Guidelines: M09 Acute Otitis Media (AOM) M29 Feverish Illness in Children by Joost Blijham
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