The Netherlands journal of medicine
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Rhabdomyolysis is a potentially life-threatening syndrome that can develop from a variety of causes; the classic findings of muscular aches, weakness and tea-coloured urine are non-specific and may not always be present. The diagnosis therefore rests upon the presence of a high level of suspicion of any abnormal laboratory values in the mind of the treating physician. ⋯ The management of the condition includes prompt and aggressive fluid resuscitation, elimination of the causative agents and treatment and prevention of any complications that may ensue. The objective of this review is to describe the aetiological spectrum and pathophysiology of rhabdomyolysis, the clinical and biological consequences of this syndrome and to provide an appraisal of the current data available in order to facilitate the prevention, early diagnosis and prompt management of this condition.
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Acute lung injury (ALI ) and its more severe form, acute respiratory distress syndrome (ARDS ), are important critical care syndromes for which the treatment options are limited once the condition is fully established. Enormous basic and clinical research efforts have led to improvements in supportive treatment, but surprisingly little has been done on the prevention of this devastating syndrome. ⋯ Early recognition of patients with or at risk of ALI /ARDS is essential for designing novel prevention and treatment strategies. Automated electronic screening tools and novel scoring systems applied at the time of hospital admission may facilitate enrollment of patients into mechanistic and outcome studies, as well as future ALI /ARDS prevention trials.
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The short- and long-term effects of a single teaching intervention for internal medicine residents are not known. Since sepsis is a prevalent and important disease and both therapeutic and diagnostic interventions have been protocolized, we investigated the effects of a sepsis-based single teaching intervention. A prospective before-and-after education study was performed among residents who attended a regional professional training for internal medicine. ⋯ Following the education session, training-grade doctors' knowledge about sepsis definitions and diagnosis and treatment of sepsis increased from (mean +/- SD ) 6.1 +/- 1.6 to 8.2 +/- 1.2 (p<0.0001. Moreover, four to six months after the teaching intervention, this effect was sustained (p<0.0001 compared with test 1), resulting in a mean score of 7.6 +/- 1.1. Our single teaching intervention resulted in improved and sustained knowledge on the assessment of symptoms, diagnosis and treatment of sepsis.