Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Mar 2008
Randomized Controlled Trial[Prevention of nosocomial infections after cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine; a prospective, randomised study].
To determine the efficacy ofperioperative decontamination of the nasopharynx and oropharynx in reducing nosocomial infection after cardiac surgery with the use of 0.12% chlorhexidine. ⋯ Decontamination of the nasopharynx and oropharynx with chlorhexidine appeared to be an effective method to reduce nosocomial infection after cardiac surgery.
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Ned Tijdschr Geneeskd · Mar 2008
Randomized Controlled Trial[Less ventilator-associated pneumonia after oral decontamination with chlorhexidine; a randomised trial].
To determine the effect of oral decontamination with either chlorhexidine (CHX, 2%) or the combination chlorhexidine-colistin (CHX-COL, 2%-2%) on the frequency and the time to onset of ventilator-associated pneumonia in Intensive Care patients. ⋯ Oral decontamination of the oropharyngeal cavity with chlorhexidine or the combination chlorhexidine-colistin reduced the incidence and the time to onset ofventilator-associated pneumonia.
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The application of oropharyngeal chlorhexidine is mainly active on Gram-positive microorganisms with only a minimal impact on colonisation by Gram-negative microorganisms. Seven randomized clinical trials have been published that showed a significant reduction in ventilator associated pneumonia (VAP) incidence, but not on survival. Some questions remain unanswered: it is presently unclear whether patients who benefit can be selected from the population at risk, and optimal formulation and dosage of chlorhexidine has not yet been established. International recommendations for using oro-pharyngeal topical chlorhexidine in ventilated patients have now been roborated by two Dutch studies.
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Ned Tijdschr Geneeskd · Mar 2008
[Perinatal mortality in The Netherlands: an audit is now more necessary than ever].
In 1999, The Netherlands was found to have the highest perinatal mortality rate (11.4 per thousand), according to the WHO definition, in comparison with 14 other European countries. Many explanations were given, amounting essentially to a higher percentage of women with one or more risk factors (higher age at delivery, more non-western immigrants, and more multiple pregnancies). Furthermore, screening for congenital anomalies was not yet an issue at that time in The Netherlands. ⋯ In The Netherlands, a nationwide perinatal audit programme will start this year. The Netherlands, with its specific obstetric care system, has the obligation to look for the causes of perinatal mortality and to introduce improvements based on the results of a perinatal audit. Hasty conclusions are a threat to a careful audit.
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Ned Tijdschr Geneeskd · Mar 2008
Review[Practical questions related to self-measurement of blood pressure].
The results of self-measurements of blood pressure predict the risk of developing cardiovascular disease better than those of blood pressure measurements taken at the GP surgery or hospital. In spite of the increasing availability of devices for home measurement, exactly how, by whom, with what and when, blood pressure should be measured at home remains unclear. Self-measurement is to be recommended as a supplement to conventional blood pressure measurement, as, in this way, the white-coat effect and masked hypertension can be recognized. ⋯ A limit for home measurement of 135/85 mmHg should be adhered to. When blood pressure measurements taken at home lead to a different conclusion than those taken at hospital or GP surgery (and if there is no white-coat or masked hypertension), it is recommended that the procedure be repeated. If after this, there is still a discrepancy between the results of these two methods of blood pressure measurement, ambulatory 24-hour blood pressure measurement will perhaps provide the definitive answer to the 'real' level of the patient's blood pressure.