Nederlands tijdschrift voor geneeskunde
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Massive investments are being made for research into the prevention and reduction of risks and diseases. False-positive outcomes from screening investigations result in fear in a substantial number of patients, and are expensive for society as a whole. ⋯ The incidence of false-positive results of colorectal cancer screening is underestimated. The risks of overdiagnosis and overtreatment as a result of screening are substantial.
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Ned Tijdschr Geneeskd · Jan 2013
[A deceased child as organ donor: a major sacrifice asked of the parents].
A shortage of organs is the key factor limiting transplantation in children. In the Netherlands, the Dutch Organ Donation Act allows voluntary registration. Citizens aged 12 years and older may register as organ donors of their own free will. ⋯ Alternatives such as living-related donor programs have been established as well as recruitment of child donors. A recent study evaluates the procurement of organs and tissues in pediatric intensive care units. This commentary questions this practice in light of voluntary registration and the resulting shortage of donor organs in general.
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If an intensive care unit (ICU) is managed by intensivists, the prognosis of critically ill patients improves. Some retrospective analyses of patient databases suggest that critically ill patients admitted to the ICU during off-hours suffer a higher mortality rate compared to patients admitted during office hours. While this suggests that this difference might be related to the presence/absence of experienced intensivists at night, differences in case mix of patients admitted during the day/night may play an important role. ⋯ Alternating every 7 nights an intensivist was present in the hospital or was available for consultation by telephone. No effect on ICU-length of stay, mortality or any of the secondary end points was found. Despite the compelling face value of nighttime intensivist staffing this practice should not be recommended in the absence of experimental evidence of its effectiveness.
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Advance directives containing a request for euthanasia in cases of severely debilitating dementia are of no use. In such an advanced stage of the disease, the doctor would have to administer lethal medication to a patient who does not realise what is happening to him/her. The Dutch Euthanasia Act is ambivalent about this possibility.
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A re-analysis of the Sydney Diet Heart Study (Ramsden et al., BMJ 2013) suggested that a diet high in linoleic acid increased the risk of coronary heart disease. The authors ascribe this to a lack of the omega-3 fatty acid, alpha-linolenic acid, in the oils and fats consumed. This argument has some weaknesses. ⋯ Additionally, the fats consumed by subjects in the intervention group were high in trans fats, which may have increased risk. Finally, a large recent clinical trial failed to show any benefit of linolenic acid. The conclusion is, therefore, that this re-analysis provides insufficient evidence to justify changes in current dietary recommendations.