Nederlands tijdschrift voor geneeskunde
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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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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
[Scan for residency programmes is a useful instrument for modernising residency training].
The modernisation of residency training programmes entails the implementation of many modifications. Revised residency training programmes, quality criteria and renewed legislation all have major consequences for residents, faculty and residency groups. Leiden University Medical Centre has developed a residency training programme evaluation tool that compares each training programme's activities with its relevant stakeholders, for example, the resident, the instructors and the central residency training committee. The outcome of this scan provides residents, instructors and central residency training committees with an overview of the current state of progression of modernisation activities, in addition to providing guidance as to the improvement of both individual training programmes and the programmes offered by institutions.
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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.
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Hidradenitis suppurativa is a chronic skin disease, characterized by painful, deep-seated inflamed lesions, mainly in areas bearing apocrine sweat glands, most commonly the axillary and inguinal regions. Pain leads to mechanical problems, and bacterial growth in the lesions produces a foul-smelling discharge, which reduces the quality of life. In this type of hidradenitis the infection occurs around hair follicles and sebaceous glands, in contrast to what the name would suggest (hidradenitis = sweat-gland inflammation); hidradenitis suppurativa can, therefore be regarded more as a form of acne. ⋯ Tumour necrosis factor-alpha inhibitors are now employed in the treatment of severe and treatment-resistant forms of hidradenitis suppurativa; under certain conditions this treatment will be reimbursed by the health insurance company. This development means that there are more treatment possibilities in hidradenitis than there were 5 years ago. The best results are achieved with a combination of antibiotic, anti-inflammatory and surgical treatment, tailored to the patient's individual situation.