Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2014
Review[Chemotherapy-induced peripheral neuropathy; impact on quality of life].
Peripheral neuropathy is a frequently occurring side-effect of chemotherapy as a cancer treatment. The incidence of chemotherapy-induced peripheral neuropathy (CIPN) is increasing as a consequence of better treatment of cancer becoming available and increasing use of chemotherapy, and because CIPN occurs more frequently with use of new chemotherapeutics. The diagnosis 'CIPN' is made principally on clinical grounds, and it is characterized by predominantly sensory symptoms. ⋯ If CIPN occurs, the only effective strategies are dose reduction or discontinuation of chemotherapy. CIPN impairs quality of life. It is important to evaluate the symptoms of CIPN, as well as the impact on daily living.
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Ned Tijdschr Geneeskd · Jan 2014
Review[Practice guideline 'Delirium' from the Dutch College of General Practitioners].
The revised practice guideline 'Delirium' of the Dutch College of General Practitioners (NHG) provides recommendations about the prevention, early detection, diagnosis and treatment of delirium in elderly patients in general practice. The guideline now also offers tools for the treatment of delirium in terminally-ill patients. A patient with delirium can only be cared for at home if a safe environment and the continuous presence of carers can be guaranteed. ⋯ The discharge from hospital of patients with persistent symptoms of delirium to their homes requires optimal transfer from the specialist/nursing staff to the general practitioner and home carers involved. The NHG guideline therefore pays considerable attention to collaboration and transfer in the care of patients with delirium. The revised version of this guideline was developed in close collaboration with the revision of the multidisciplinary guideline on delirium produced by the Dutch Order of Medical Specialists.
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In the past 10 years there have been major advances in the treatment of cardiac arrest by the application of therapeutic hypothermia (TH). TH is a safe treatment option, providing the physiological effects are taken into consideration and providing the potential pitfalls of application of hypothermia are avoided. TH (32-34°C) is just as safe and effective as cooling to 36°C ('near-normal temperature'). ⋯ The broad spectrum of pathophysiological mechanisms by which therapeutic hypothermia exerts its effect on organism in a hypoxic situation suggests a potential wider role for this therapy than in current daily clinical practice. Cardiogenic shock is no longer regarded as a contraindication for TH; in the past few years the safety and effectiveness of this treatment have been proven in patients with cardiogenic shock. In fact, the anti-ischaemic and positive inotropic effects of TH suggest that this treatment could be a potential treatment specifically for patients with cardiogenic shock.
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Ned Tijdschr Geneeskd · Jan 2014
Case Reports[A woman with knee locking after a partial knee arthroplasty].
A 57-year-old woman presented with knee locking and lateral knee pain after a partial knee arthroplasty. Consequently, during knee arthroscopy 2 cement particles were found and removed.
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To map the relation between metformin prescription and renal function in an outpatient setting. To investigate whether there is an association between renal function, metformin concentration and lactate concentration. ⋯ Our study shows that in outpatient practice, the metformin dose is not sufficiently adjusted to a reduced renal function in 31% of the patients. The accumulation of metformin appears to be associated with an increased lactate concentration and a reduced renal function. Extra attention to the dose of metformin in reduced renal clearance is therefore recommended.