Nederlands tijdschrift voor geneeskunde
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New biomedical technologies make it possible to replace parts of the human body or to substitute its functions. Examples include artificial joints, eye lenses and arterial stents. Newer technologies use electronics and software, for example in brain-computer interfaces such as retinal implants and the exoskeleton MindWalker. ⋯ Second, because in western thought the human mind, and not the body, is considered to be the seat of personhood. However, it has been argued by phenomenological philosophers that the body is more than just an object but is also a subject, important for human identity. From this perspective, we can appreciate that a bionic body does not make one less human, but it does influence the experience of being human.
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Ned Tijdschr Geneeskd · Jan 2013
Multicenter Study Meta Analysis[Improved end-of-life care for patients with dementia: greater family satisfaction and possibly greater end-of-life comfort].
To analyse possible trends in families' evaluations of the quality of end-of-life care and the quality of dying in dementia. ⋯ We found a positive trend of increased satisfaction with end-of-life care. Families also reported a possible increase in residents' end-of-life comfort. Ongoing surveillance of outcomes measuring end-of-life quality is important in view of the increasing healthcare budget constraints.
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Ned Tijdschr Geneeskd · Jan 2013
Review[Juvenile idiopathic arthritis: from biomarker to treatment].
Juvenile idiopathic arthritis (JIA) is the most common cause of chronic joint inflammation in childhood. The aetiology is unknown and the pathogenesis is multifactorial. JIA manifests itself in many various ways. ⋯ MRI examination is playing an increasingly important role in making a correct early diagnosis and in assessing response to therapy. After 6 months JIA patients are classified, based on clinical characteristics and laboratory results, into one of the JIA categories according to the criteria of the International League of Associations for Rheumatology. Recent developments in therapy, such as starting biological treatment at an early stage, have led to an improvement in the prognosis of JIA and to structural joint damage occurring less often.
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Ned Tijdschr Geneeskd · Jan 2013
Review[Terminal care in patients with amyotrophic lateral sclerosis].
Patients with amyotrophic lateral sclerosis (ALS) often fear of dying from suffocation. This fear is also common in relatives and caregivers. Research has, however, shown that ALS patients seldom die from suffocation. ⋯ Intensive guidance of the relevant medical, practical and ethical aspects are necessary. Particularly in the pre-terminal and terminal phases, support given to an ALS patient requires a pro-active attitude on the part of the treating physician. To this end, physicians may seek advice from the Dutch ALS Center, a palliative care consultation team, a hospice physician or a center for home mechanical ventilation.
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Ned Tijdschr Geneeskd · Jan 2013
Review['Postoperative pain treatment' practice guideline revised].
On the initiative of the Dutch Association of Anaesthesiologists, a multidisciplinary workgroup has revised the 2003 practice guideline on 'Postoperative pain treatment' for adults and children. The main reason for revision was the availability of new drugs and new methods of administration. The most important deviations from the previous edition are the following. ⋯ In patients with relative contraindications for epidural analgesia, peripheral and locoregional blocks or multimodal pain treatment are advised. In the case of postoperative nausea and vomiting, administration of dexamethasone, droperidol and 5-HT3-antagonists is recommended, preferably in combination. Non-medicinal treatment options are not recommended.