Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · May 2003
Comment[Intensive care medicine in the Netherlands, 1997-2001. I. Patient population and treatment outcome].
To describe the patients admitted to intensive care units (ICUs) in the Netherlands between 1997-2001 and the treatment outcome. ⋯ Hospital mortality for ICU-admitted patients in the NICE registration was 12.9%. For patients who could be evaluated with the APACHE II model, actual hospital mortality was lower than predicted by this model. Significant differences in length of admission, hospital mortality and SMR were found between individual hospitals.
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Ned Tijdschr Geneeskd · May 2003
Comparative Study[Intensive care medicine in the Netherlands, 1997-2001. II. Changes over time and differences between hospitals].
To describe efficacy (mortality) and efficiency (length of admission) of intensive care (IC) treatment after admission due to a prior cardiothoracic operation or pneumonia, based on data from the Dutch National Intensive Care Evaluation (NICE) foundation. ⋯ With the NICE registration it is possible to detect differences and trends. This is a valuable tool for indicating where and how quality and efficiency in intensive care medicine can be improved.
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Ned Tijdschr Geneeskd · May 2003
Review[Summary of the Dutch College of General Practitioners' practice guideline 'Delirium in elderly people'].
The Dutch College of General Practitioners' practice guideline 'Delirium in elderly people' contains a number of key messages. These are: Consider the diagnosis of delirium in the case of changes in consciousness and attention, incoherent thinking or disorientation, if this picture developed over a short period of time (hours to days) and if the symptoms vary over the 24-hour period. Delirium is provoked by one or more somatic disorders; investigation and treatment of these disorders is an essential part of managing delirium. ⋯ Although delirium is generally reversible, the prognosis in the elderly is relatively poor. If delirium is accompanied by fear or agitation, haloperidol is the drug of first choice, but in delirium induced by alcohol withdrawal or benzodiazepine withdrawal, a short-acting benzodiazepine such as lorazepam or oxazepam is indicated. Part of the treatment, but also prevention of delirium is focused on inducing factors that can provoke a delirium, such as medication with an anticholinergic effect, polypharmacy, inadequate nutrition, dehydration, sleep deprivation, immobility and sensory handicaps.
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Ned Tijdschr Geneeskd · May 2003
[The Dutch College of General Practitioners' practice guideline 'Delirium in elderly people'; response from psychiatry].
Delirium is a common psychiatric illness among the medically ill and is associated with significant morbidity and mortality. Although delirium may develop at any age, the elderly are particularly vulnerable. Since the number of elderly with chronic diseases, dementia, sensory handicaps and the use of several (anticholinergic) medications--all predisposing factors for delirium--is rising, it is essential that general practitioners can recognise, adequately diagnose and treat delirium. ⋯ Evidence on clinical features, differential diagnosis, prevalence, course, aetiology, and risk factors for delirium in primary care is lacking. In general hospitals, the prevalence of delirium in the elderly is about 10-40%; it is probably much less in primary care. This guideline does not provide an adequate description of the clinical presentations of delirium, and does not sufficiently stress the importance of recognising any new behavioural problem in an elderly patient as an indication of possible delirium.