Nederlands tijdschrift voor geneeskunde
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A 10-year-old boy consulted a dermatologist with a painful, subungual tumour on one of his toes. X-ray showed an outgrowth of the distal phalanx and histopathological investigation showed osteochondromatous proliferation. ⋯ Subungual exostoses are benign osteocartilaginous tumours that occur beneath the nail bed. Excision was performed, the patient recovered well.
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Aspiration of gastric contents during or after induction of anaesthesia can be prevented by adhering to preoperative fasting guidelines of 6 hours for solid foods and 2 hours for clear liquids. There are frequent cases in which the patient cannot be regarded as having fasted; this applies in particular to non-planned acute or semi-acute patients. Instead of postponing surgery to later the same day or even the next day, there are alternatives, such as bedside ultrasound assessment of the stomach volume or accelerating gastric emptying by administering a low dose of erytromycin. These options can contribute to a more efficient planning of surgery and a higher level of comfort for the patient.
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Ned Tijdschr Geneeskd · Jan 2014
[Accidents involving a motorized mobility scooter: a growing problem].
To analyze injury patterns, injury severity and mortality among victims of motorized mobility scooter (MMS) crashes in relation to the trauma mechanism and patient's age. ⋯ Low-energy as well as high-energy crashes involving the MMS may result in serious injuries and sometimes death. Awareness by multidisciplinary treatment teams may help to avoid underestimation of injury severity. MMS drivers need to improve their driving skills in order to reduce the number of MMS crashes.
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Ned Tijdschr Geneeskd · Jan 2014
Comment[A limited role for telemedicine on the Dutch intensive care].
The use of telecommunication and information technology has evolved rapidly in many areas. However, it has not kept pace for the organisation of medicine. It can be expected that e-Health will revolutionise the landscape of medicine in the coming years. ⋯ This cannot be compared with the Dutch situation where there are short distances between hospitals, ubiquitous, excellent infrastructure for patient transport and a sufficient number of intensivists. Furthermore, an ICU is not only characterised by its own means in terms of human resources and equipment, but also by the 24/7 availability of other (critical) medical specialities in the hospital. The contribution of tele-ICU is therefore limited in the Netherlands but might play a role for second opinions and consultation for highly specialized expertise.
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Antimicrobial resistance is an increasing health care problem, both abroad and in the Netherlands, and its main driving force is antibiotic use. In patients with pneumonia or sepsis, appropriate antibiotic use has been associated with improved clinical outcome, shorter length of hospital stay, decreased bacterial resistance and reduced costs. ⋯ A social and behavioural scientific approach with different intervention strategies - restrictive and persuasive - is required if antibiotic prescription in hospitals is to be improved. As a part of this antimicrobial stewardship programme, antibiotic teams (A-teams) must be introduced in all hospitals in 2014.