Nederlands tijdschrift voor geneeskunde
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As paracetamol is widely used and easily available acetaminophen auto-intoxication is frequently seen. In the majority of patients no complications will occur, but in a small group it may lead to liver damage and death. Children are less susceptible to complications than adults. ⋯ This nomogram has only been validated in adults, but nevertheless is also used in children. Gastric lavage should not be implemented, active charcoal can be given to a conscious cooperative patient within 1 hour of ingestion of acetaminophen. A multidisciplinary approach to treatment is needed with the collaboration of an emergency physician, paediatrician or internist, pharmacist and also a child psychiatrist.
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A 62-year-old man fell from a ladder, after which he could not lower his right arm. X-ray and CT-scan showed inferior luxation of his shoulder (luxatio erecta). A reduction procedure was performed.
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Ned Tijdschr Geneeskd · Jan 2011
Review[Shared decision-making in medical practice--patient-centred communication skills].
Most patients (70%) want to participate actively in important healthcare decisions, the rest (30%) prefer the doctor to make the decision for them. Shared decision-making provides more patient satisfaction, a better quality of life and contributes to a better doctor-patient relationship. ⋯ In shared decision-making the doctor asks many open questions, gives and requests much information, asks if the patient wishes to participate in the decision-making and explicitly takes into account patient circumstances and preferences. Shared decision-making should remain an individual choice and should not become a new dogma.
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Ned Tijdschr Geneeskd · Jan 2011
Review[Uterus preserving surgery versus vaginal hysterectomy in treatment of uterine descent: a systematic review].
To compare the outcomes of uterus preserving procedures and vaginal hysterectomy in treatment of uterine prolapse. ⋯ Although some uterus preserving procedures are associated with shorter operation time, shorter duration of hospital stay and less blood loss than vaginal hysterectomy, based on the current literature there is no clear preference for either uterus preserving surgery or hysterectomy in surgical treatment of uterine descent, since randomised trials of sufficient quality are lacking. Prospective clinical randomised trials with long term follow-up are needed to investigate the value of uterine preserving procedures.
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Ned Tijdschr Geneeskd · Jan 2011
Review[Transfusion policy in trauma involving massive blood loss].
Severe haemorrhage is a significant cause of death in trauma patients. In the case of massive blood loss a combination of coagulation defects, acidosis and hypothermia arise, which are accompanied by high morbidity and mortality rates unless properly corrected. ⋯ Unnecessary FFP transfusions in trauma patients without imminent severe haemorrhage increase the risk of complications such as multi-organ failure and acute respiratory distress syndrome. Additional research is required into the accuracy of diagnosis of acute coagulation disorders.