Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
[The 'paper-based' preoperative evaluation: sometimes, a suitable alternative].
In the Netherlands, the majority of elective-surgery patients are evaluated by the anaesthesiologist at the preoperative assessment clinic. We believe that this visit can be omitted in selected patients as it has only minimal benefit, whereas its disadvantages can be substantial. Alternatively, the initial screening could be performed by the completion of a questionnaire via the telephone, via internet, by a nurse or by the surgeon. ⋯ This method does require the conscientious cooperation between anaesthesiologists and surgeons; it should be clear which patients are eligible, what type of anaesthetic technique should be used, how the patient should be informed and how the informed consent is obtained. In our opinion, this paper-based evaluation combines safety and efficiency with patient-friendliness. It should be anchored in current guidelines to ensure quality.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[Hip fracture in patients with dementia: surgery is not always the best alternative].
Patients with dementia are at risk of hip fracture. The prognosis of rehabilitation after surgery is less favourable than in the general population, because of higher mortality, more complications and a longer rehabilitation period. We present 2 female patients with dementia (77 and 86 years old) who each received a different therapy: one surgical, the other conservative. ⋯ When making a medical decision, it is important to consider if a treatment is effective, proportional and if the intended outcome is desirable. In some cases of hip fracture in patients with dementia, conservative treatment and withholding surgery can be good care. More investigation is needed for further evidence-based decision-making.
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Postoperative ileus is a commonly occurring complication after abdominal surgery. Reduced well-being and ileus related complications lead to extension of hospital stay. ⋯ However, these studies were small in size and of varying quality. Recently the "Chewing gum study" ("Kauwgomstudie") to investigate the effect of general use of chewing gum after abdominal surgery has been started in the Netherlands.
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Pericarditis is seen quite often in daily clinical practice. It is a condition that is fairly easy to diagnose, but which frequently recurs. ⋯ Chest pain in young people can be a symptom of pericarditis. This condition quite often recurs, but in most patients no underlying cause is revealed. Adequate medication with calcium carbasalate and colchicine reduces the chance of recurrence.
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Ned Tijdschr Geneeskd · Jan 2012
Practice Guideline[Multidisciplinary guideline 'Recognition and treatment of chronic pain in vulnerable elderly people'].
Chronic pain in vulnerable elderly people is still poorly recognized and treated, both at home and in hospitals and care and nursing homes. Vulnerable elderly people experience and express pain differently to relatively healthy adults, especially when they suffer from cognitive impairment or specific conditions. Determining the nature and severity of the pain requires the use of pain assessment instruments that have been validated for use in vulnerable elderly people. ⋯ The combination of multiple morbidity and poly-pharmacy increases the chance of side-effects and complications. In addition, the pharmacokinetic and pharmacodynamic characteristics of many drugs are different in vulnerable elderly people. The advice is to start with a lower dose of pain medication and gradually build up a level on the basis of pain relief and side-effects ('start low, go slow!').