Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Dec 2008
[The practice guideline 'Children with fever' (second revision) from the Dutch College of General Practitioners; a response from the perspective of paediatricians].
The new version of the practice guideline 'Children with fever' was recently published by the Dutch College of General Practitioners and is commented on from the perspective of paediatricians. Whether or not general practitioners should refer feverish children to the paediatrician depends on the age of the patient and the severity of the illness. All children younger than 1 month and children with warning symptoms should be referred to a paediatrician at once. ⋯ Emphasis is put on the fact that infections are dynamic processes and therefore good follow-up is important. Children under the age of 2 years with a fever with no apparent cause should be re-examined after 24-48 h. Parents should be properly instructed to come back for re-examination of their child if the clinical picture changes or worsens.
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Delirium is a common condition in the intensive care unit (ICU). Between 16-89% of all ICU patients experience an episode of delirium during admission. Several detection tools have been developed for use specifically in the ICU. ⋯ The prognosis for ICU patients who experience delirium is worse than for those who do not. Delirious patients are more likely to develop complications, spend longer in hospital and have a higher mortality rate. In view of the high frequency, poor prognosis, high costs and lack of studies into the treatment of ICU delirium, research into the possibilities for prevention, early detection and treatment of the condition is essential.
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Ned Tijdschr Geneeskd · Dec 2008
Case Reports[Diagnostic image (400). A woman with a smooth tongue surface. Pernicious anaemia].
A 49-year-old woman with exertional dyspnoea had a pale skin and an atrophic tongue due to pernicious anaemia.
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In The Netherlands a perinatal audit system is being prepared. Perinatal audit is seen as a powerful means of identifying substandard factors in perinatal care and of increasing the quality of care with better grounding. ⋯ These aspects include the rights of patients with respect to privacy and information and the protection of health professionals against use of information from the audit system for reasons other than quality purposes. Legislation from other countries may inspire legislative developments in The Netherlands in this area.
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Ned Tijdschr Geneeskd · Dec 2008
Comment[Obstetric care in The Netherlands under assessment again].
According to the Peristat II study, based on data from 2004, The Netherlands has almost the highest perinatal mortality rate in Europe. In 2006 perinatal mortality in The Netherlands was also higher than in the Flemish part of its neighbouring country Belgium (10.40 per thousand versus 7.76 per thousand). ⋯ Since the Peristat I publication many measures have been taken in The Netherlands in order to improve the quality of perinatal care. The most important are the start of the perinatal audit preparations, better prenatal screening and the introduction of preconception care.