Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Feb 2008
Practice Guideline[Summary of the practice guideline 'Sore throat' (second revision) from the Dutch College of General Practitioners].
The second version of the practice guideline 'Sore throat' has been updated from the 1999 version. --Infections of the throat generally cure spontaneously within 7 days. In most cases the sore throat is caused by a virus. ⋯ This diagnosis can be verified by a test for IgM against Epstein-Barr-virus. --Additional investigations to detect GABHS are not recommended. --Prescribing antibiotics is only recommended for patients who have a severe throat infection or an increased risk of complications. Pheneticillin or phenoxymethylpenicillin remains first choice. --Referral for tonsillectomy should meet the following criteria: 5 or more episodes of sore throat per year or 3 or more episodes per year in the last 2 years.
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Ned Tijdschr Geneeskd · Feb 2008
Comment[The practice guideline 'Sore throat' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].
Compared to the original version and the first revision of the practice guideline 'Sore throat', the second revision by the Dutch College of General Practitioners is clearer and gives practical advice on how to handle. In the Netherlands, most patients who visit their GP due to a sore throat expect antibiotics to be prescribed. Most of these patients will indeed receive a prescription for an antibiotic from their GP. ⋯ Antibiotic treatment is only necessary for severe throat infections. Moreover, most cases of sore throat caused by group A betahaemolytic streptococci will cure spontaneously within one week. It is hoped that this guideline will act as a backup for practicing GPs to enforce critical prescription behaviour.
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Ned Tijdschr Geneeskd · Feb 2008
Comment[The practice guideline 'Sore throat' (second revision) from the Dutch College of General Practitioners; a response from the perspective of otorhinolaryngology].
In this comment, the practice guideline 'Sore throat' (second revision) is discussed. This guideline, composed by the Dutch College of General Practitioners, offers general practitioners a well-appreciated overview of the common practices regarding diagnostic tests and treatment of pharyngitis and tonsillitis.
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Ned Tijdschr Geneeskd · Feb 2008
Review[Prognosis for patients in a coma following cardiopulmonary resuscitation].
Most patients with post-anoxic coma after resuscitation have a poor prognosis. Reliable prediction of poor outcomes (death or vegetative state after 1 month; death, vegetative state or severe disability after at least 6 months) at an early stage is important for both family members and treating physicians. ⋯ The predictive value of a status epilepticus or serum levels of neuron-specific enolase is uncertain at this time. In contrast to poor outcomes, good neurological recovery cannot be predicted reliably at this time.
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Ned Tijdschr Geneeskd · Feb 2008
Review[Induced mild hypothermia to limit neurological damage after resuscitation].
Despite improvements in resuscitation techniques, the prognosis for patients who experience cardiac arrest outside of a hospital remains relatively poor. This is mainly due to brain damage that occurs as a result of global cerebral ischaemia. In 2002, two prospective randomised multicentre studies demonstrated that induced mild hypothermia can increase the chance of good neurologic recovery after out-of-hospital cardiac arrest by at least 40%. ⋯ A safe and effective method to induce mild hypothermia is the infusion of cold fluids during sedation and mechanical ventilation. Cardiac function, renal function and electrolytes must be monitored closely during induced mild hypothermia. Given the potentially deleterious effects of rapid rewarming, a maximal rewarming rate of 0.5 degrees C per hour is recommended.