Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2010
[Implementation of the curriculum for specialist training in Emergency Medicine: room for improval on details].
To investigate what aspects of the new curriculum for specialist training in Emergency Medicine are actually implemented in daily practice. ⋯ The responses to the questionnaire demonstrated how the curriculum is handled in daily practice and provided information on the progress of the implementation of the curriculum. This will enable focussed feedback to teaching hospitals.
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Ned Tijdschr Geneeskd · Jan 2010
[Outcomes of 16 years of oesophageal surgery: low postoperative mortality and improved long-term survival].
To assess trends in patient characteristics and treatment outcomes in a large cohort of patients who underwent oesophagectomy for oesophageal carcinoma in a tertiary referral centre over a period of 16 years. ⋯ Over the past 16 years in-hospital mortality in patients undergoing oesophagectomy for a potentially curable oesophageal carcinoma at the AMC, has been stably low. The total number of complications increased during these periods. Long-term survival improved during this time to a three-year overall survival of more than 50% in the most recent period.
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Ned Tijdschr Geneeskd · Jan 2010
Practice Guideline[Guideline 'Diagnosis and treatment of inflammatory bowel disease in adults'. II. Special situations and organisation of medical care].
The Dutch national practice guideline 'Diagnosis and treatment of inflammatory bowel diseases (IBD) in adults' describes the multidisciplinary approach for adult patients with (suspected) IBD, recommended following analysis of the literature according to the principles of evidence based guideline development. Ulcerative colitis and Crohn's disease are associated with temporary or permanent extra-intestinal disorders: reactive inflammatory conditions, associated conditions, and those arising as a consequence of long standing, inflammatory, intestinal disease. Treatment is aimed first at the IBD disease process and subsequently at the specific extra-intestinal conditions if complaints persist. ⋯ These positive findings have not yet been incorporated into the practice of life insurance providers. The diversity of IBD patient health care and its delivery by many professionals places stringent requirements on the organisation of care by hospitals and those providing treatment. The transfer process from paediatric specialist to gastroenterologist affects both patients and parents deeply.
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Ned Tijdschr Geneeskd · Jan 2010
[Acute upper-airway obstructions in primary care. Cricothyrotomy performed by the general practitioner].
Acute upper-airway obstructions, especially epiglottitis, are being observed with increasing frequency in adults, both in the hospital situation and in general practice. Acute upper-airway obstructions are life-threatening and therefore need to be treated with the highest priority. When interventions such as manual removal of a foreign body, thoracic compression or the Heimlich manoeuvre fail, the only remaining interventions are intubation and cricothyrotomy. ⋯ Should all GPs be trained in performing life-saving interventions such as cricothyrotomy? This is a difficult question; the intervention is invasive and has a high risk of complications, but securing the airway is a critical life-saving measure. Above all, there is very limited time available to wait for more experienced help. Therefore, we believe that GPs should be trained in performing life-saving interventions such as cricothyrotomy.
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Ned Tijdschr Geneeskd · Jan 2010
Case Reports[Severe, subacute axonal polyneuropathy due to hypophosphatemia].
A 46-year-old man receiving tube feeding because of anorexia and weight loss developed progressive neurological symptoms initially resembling Guillain-Barré syndrome. Eventually axonal neuropathy due to severe hypophosphatemia was diagnosed. ⋯ The neurological manifestations of hypophosphatemia are reversible if oral or intravenous suppletion of phosphate is started in time. Recognizing the refeeding syndrome is crucial in making a timely diagnosis.