Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2009
[Mild therapeutic hypothermia following resuscitation; experience and results in the first two years after introduction].
To describe the results of mild therapeutic hypothermia (MTH) following resuscitation in the 'Gelderse Vallei' hospital, Ede, the Netherlands. ⋯ The introduction of MTH in the intensive care department of the "Gelderse Vallei" has taken place without major problems. Although the mortality rate following cardiopulmonary resuscitation was relatively high, the neurological outcome in those patients who were discharged from hospital alive was good.
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Energy policy and climate policy are two different issues and should not be treated as if they were the same. Whether the climate gets warmer or colder, saving energy and developing sustainable forms of energy production remain of paramount importance because fossil hydrocarbons are likely to be exhausted soon. But climate policy is a fallacy: it is human arrogance to think we can control the climate by reducing emissions and by storing CO2 underground. ⋯ Since the International Panel on Climate Change (IPCC) did not predict this, it is questionable whether they can reliably predict warming. Other factors such as solar activity are probably more important for climate than greenhouse gases. The danger of coupling energy policy to climate policy is evident: if the climate cools down, people will lose belief in the greenhouse effect and therefore also lose interest in saving energy.
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Ned Tijdschr Geneeskd · Jan 2009
[Medicinal use of cannabis in the Netherlands: towards a responsible pattern of use].
Since 2003, medicinal cannabis has been legally cultivated and distributed in the Netherlands under the auspices of the Dutch Office of Medicinal Cannabis (BMC), part of the Ministry of Health, Welfare and Sport. As a result of this measure, the indication, dosage, administration route, and safety of cannabis can now be investigated, information necessary for justifying its potentially future position as a standard medicinal product. Despite the current lack of reliable scientific efficacy data, standardised medicinal cannabis without microbes has also been made available on prescription. ⋯ Despite disappointing sales at the end of 2007, the Minister of Health, Welfare and Sport has announced that the current policy will be extended for a further five years. The Minister also indicated that he would consider discontinuing the availability of medicinal cannabis for patients, if new cannabis products are granted market authorization. This might, however, give rise to a new era of illegal cannabis use for medicinal purposes, notably for the use as a whole product.
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Intensive insulin therapy for critically ill patients is implemented as standard therapy in many ICUs, even though the evidence supporting this approach comes from just two studies at a single centre. Moreover, the results could not be repeated in other multicenter trials and there is increasing evidence of a risk of hypoglycaemia. However, it appears that many intensive care specialists have been too zealous in their attempts to attain euglycemia during critical care. A recent RCT with over 6000 patients demonstrated that intensive glucose control increases mortality by 2.4%.