Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
Comment[Role of secondary care too small in Dutch College of General Practitioners' (NHG) practice guideline 'Dementia'].
The third revision of the Dutch College of General Practitioners' practice guideline 'Dementia' is a major improvement and stimulates the general practitioner by providing concrete advice on stepped care in dementia diagnostics and organizing care management in order to obtain improvement in the quality and realization of dementia care in the primary care setting. However, this practice guideline does not address more effective and efficient dementia care by collaboration between primary and secondary care as it discourages the prescription of cholinesterase inhibitors and recommends limiting further diagnostic procedures to patients in whom a treatable condition is likely. Although, this new practice guideline strengthens the central role of the general practitioner in Dutch dementia care, this role would be further reinforced if general practitioners were to adopt integrated diagnostics of dementia and relevant additional diseases burden as the starting point.
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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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Ned Tijdschr Geneeskd · Jan 2012
[Dutch military casualties of the war in Afghanistan--quality of life and level of participation after rehabilitation].
To describe the distribution of injuries and the quality of life and functioning at activity and participation level of rehabilitated Dutch military personnel who were wounded during the mission to Afghanistan. ⋯ The quality of life and functional level of Dutch military personnel who were injured in combat in Afghanistan seemed to be lower than in the general population after 2.3 years. For a large part this could be explained by the level of mobility and occupation.
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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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An 85-year-old woman with a severe kyphosis presented at the emergency room because of progressive dyspnea and cough, without other complaints. During auscultation, peristaltic sounds were heard over the thorax. A massive diaphragmatic hernia with intrathoracic stomach, small intestine and colon, was seen on CT-scan.