Nederlands tijdschrift voor geneeskunde
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In the last week of life, the extent and kind of medical practice differ both in intention and in the degree of orientation on the outcome. Patients tend to put long-term prescriptions aside or ask for symptom-relieving medication and sometimes for palliative sedation, euthanasia or physician-assisted suicide. Competent physicians are able to offer or withhold treatment. ⋯ In 2005, standard drugs (choice, dose and route of administration) were highly effective in all cases of euthanasia in which they were used (76%): death within a median of 3-4 min, maximum 90 min. In the absence of medical indications for drug overdose, morphine and other choices are now considered obsolete for euthanasia and physician-assisted suicide. The definition of euthanasia must be based exclusively on a standard method and outcome: death on request by a standard medical method with a standard judicial review.
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Ned Tijdschr Geneeskd · Mar 2006
Comment[The use of complementary and alternative medicine in children: how to advise the parents?].
Recently it has been shown that complementary or alternative medicine (CAM) is used in about 30% of paediatric patients. Is this a problem? It has also been shown that most parents would like their paediatrician to advise them on the subject. ⋯ Society and the medical profession are notoriously ambiguous on the subject. Sound scientific evidence is advocated to make bold decisions on whether to allow and reimburse the use of CAM.
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Ned Tijdschr Geneeskd · Mar 2006
[A single nighttime trauma helicopter does not represent a significant improvement in emergency assistance].
The medical benefits of nighttime missions by one single helicopter emergency medical service for trauma patients in the Netherlands are probably outweighed by the high risk for the crew and the general obstacles to nighttime flight operations. It is doubtful whether one nighttime trauma helicopter will have a favourable effect on the morbidity and mortality due to major trauma in the Netherlands. However, extending the role of regional centres in pre-hospital emergency medicine could be an approach to achieving long-term improvements in trauma care.
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Ned Tijdschr Geneeskd · Mar 2006
Review[Potential role for probiotics in the prevention of infectious complications during acute pancreatitis].
Acute pancreatitis has a high mortality in case of secondary infection of (peri-)pancreatic necrosis. Bacterial translocation is held responsible for the majority of these infectious complications of severe acute pancreatitis. ⋯ Recently, several randomised, double-blind, placebo-controlled trials evaluating prophylactic treatment with enteral probiotics have shown good results. A Dutch multicentre trial, 'Probiotics in pancreatitis trial' (PROPATRIA), is currently underway.