Nederlands tijdschrift voor geneeskunde
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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!').
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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
Case Reports[A neonate with peculiarly arranged skin abnormalities].
A tropical doctor reviewed a female Malawian neonate with a vesicular rash and linear hyperpigmentation that followed the lines of Blaschko. This distribution is typical for incontinentia pigmenti, a congenital X-linked dermatosis, which usually resolves spontaneously in adolescence.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[Fatal respiratory failure in a morbidly obese patient].
Healthcare professionals are seeing an increasing number of morbidly obese patients. Medical interventions are often difficult to perform in these patients. In acute situations this can lead to major problems. ⋯ Designating centres for care, also in the acute situations, of morbidly obese patients is recommended, to improve the care of these patients and to prevent disasters.
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Ned Tijdschr Geneeskd · Jan 2012
Practice Guideline[Prevention of severe infections in patients with hyposplenism or asplenia].
Each year, up to a 1000 splenectomies are performed in the Netherlands. Aside from patients without a spleen, there is also a large group of patients with hyposplenism or functional asplenia due to other primary diseases. ⋯ Healthcare professionals in first and secondary care in the Netherlands are generally not well informed about which preventive measures should be taken to prevent these infections, resulting in often suboptimal management of patients. In this article, recommendations are given on vaccination and administration of antibiotics to prevent severe infections such as PSS in this group of patients.