Nederlands tijdschrift voor geneeskunde
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In 2 patients, a woman aged 38 years and a man aged 48 years, in the terminal phase of life due to metastasized+ malignancy, palliative care failed. They suffered seriously from pain, delirium, restlessness, nausea, and fear. ⋯ Deep sedation is an option when palliative care fails to diminish serious suffering. Midazolam, given by continuous subcutaneous infusion is the drug of choice.
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Ned Tijdschr Geneeskd · Dec 1999
Review[Medical decisions, cost considerations and clinical practice guidelines; comments from the legal point of view].
Physicians are expected to take into account the cost of medical decisions. From a legal point of view, this need not to be problematic as long as it does not detract from good care. ⋯ This means that clinical practice guidelines cannot be based, at least not to an unlimited extent; on cost-effectiveness, if they are to retain their professional character. If this restriction is not respected and cost-effectiveness based guidelines are not distinguished from professional ones, a likely result is confusion over their legal status and over the professional duties and liability of physicians.
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Ned Tijdschr Geneeskd · Dec 1999
Review Case Reports[What should be done if a patient refuses treatment after self- poisoning?].
Three women aged 28, 30 and 39 years, attending an emergency room because of attempted suicide by means of an overdose of drugs, refused somatic treatment considered necessary: one refused gastric lavage and two refused to remain in the hospital. After explanation of the procedure, one patient left the clinic without treatment and one agreed to admission--both were subsequently treated in the outpatient department. ⋯ Obligatory gastric lavage after (auto)intoxication is possible under the Medical Treatment Agreement Act (WGBO) and should follow its rules. However, this may be avoided by using a laboratory test or ECG for the diagnosis and administration of activated charcoal and a laxative for the treatment.
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Ned Tijdschr Geneeskd · Dec 1999
Comment Review['Urinary tract infections'--revised CBO guideline. Dutch Institute for Quality Assurance].
Recently the 'Kwaliteitsinstituut voor de gezondheidszorg CBO' (Dutch Institute++ for Health Care Improvement) published revised guidelines on urinary tract infections. In children less than one year old clinical signs of urinary tract infection are non-specific and the diagnosis should be ruled out by laboratory investigations: a nitrite test, followed by inspection of the urinary sediment for leucocytes and bacteria if the test is negative. If one of the investigations is positive an urinary culture is made and antimicrobial therapy is started as for pyelonephritis. ⋯ Urinary catheters are a risk for infection and their use should be restricted in number and duration. Catheter care should follow the guidelines of the Workgroup Infection Prevention. Urinary cultures should only be made in the presence of signs of infection if there is an indication for antimicrobial therapy.
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Ned Tijdschr Geneeskd · Dec 1999
Case Reports[Intracerebral tuberculomas in a pregnant Somalian woman].
A pregnant Somalian woman aged 28 years, in the Netherlands for the last five years, suffered from a progressive hemiparesis, epilepsia, behavioural problems and low fever. Brain MRI showed multiple lesions with contrast enhancement. Extensive serologic and parasitologic tests on serum and cerebrospinal fluid did not disclose any cause. ⋯ In the meantime the chest X-ray showed miliary tuberculosis and a spine MRI thoracic spondylodiscitis and a large paravertebral abscess. Subsequently the patient was treated successfully with tuberculostatic agents. Her healthy child which was born by caesarean section was treated with the tuberculostatic agents as well.