Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2015
Review Case Reports[Treatment of breakthrough pain in cancer patients].
Pain is common in patients with cancer (33-64%) and can be divided into background and breakthrough pain (BTP). BTP is a passing, acute pain that occurs despite the use of analgesia to control background pain. BTP may arise spontaneously or be provoked by certain movements or activities. ⋯ Both patients had to wait too long before they received their BTP medication, causing the BTP to have passed its peak. After consultation with their nurses, both patients were allowed to have one dose of breakthrough medication in advance, which resulted in better treatment of their BTP. Every hospitalized patient with BTP should have one dose of breakthrough medication ready for taking in advance.
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Ned Tijdschr Geneeskd · Jan 2015
Historical Article[The first Dutch debate on anaesthesia in obstetrics].
After the publication of the Dutch medical guideline on pharmacological analgesia during childbirth in 2008, the question of whether pharmacological pain relief should be permissible during labour was hotly debated. This discussion has been going on since the second half of the 19th century when the introduction of ether and chloroform was extensively studied and described in Great Britain. ⋯ Study of historical journals and textbooks, originating in the Netherlands and elsewhere, and of historical medical literature on anaesthesia and obstetrics shows that the Dutch protagonists adopted more nuanced ideas on this issue than many of their foreign colleagues. This description of the first Dutch debate on anaesthesia in obstetrics shows that in fact the issues and arguments are timeless.
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Ned Tijdschr Geneeskd · Jan 2015
Case Reports[A young woman with skin necrosis after sclerotherapy].
A 23-year-old woman developed painful skin necrosis after injections with lauromacrogol 400 for varicose veins. This complication, called embolia cutis medicamentosa or Nicolau syndrome, is characterised by acute pain and necrosis of the skin, subcutaneous tissue and muscle. Surgical intervention by local excision seems to be the best therapy.
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Ned Tijdschr Geneeskd · Jan 2015
[The automated external defibrillator in the resuscitation chain. The importance of the AED examined].
The survival rate for those suffering an out-of-hospital cardiac arrest (OHCA) is improving slowly, with > 90% of the survivors being discharged from hospital with cognitive function intact. A recent analysis of the ARREST (AmsteRdam Resuscitation Study) group documented an increase in survival rates with favourable neurological outcome from 16.2% in 2006 to 19.7% in 2012. ⋯ A recent analysis of the ARREST database points to the increasing use of AEDs (by laypersons, but particularly by police officers and fire-fighters with a training in basic life support) as one of the main drivers of this improved prognosis. An AED is now used in 59% of OHCA in the greater Amsterdam area, and has become an essential link in the resuscitation chain.
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Ned Tijdschr Geneeskd · Jan 2015
[Psychotropic drug prescription to people with intellectual disability in GP practices].
Antipsychotic drugs are more often prescribed in primary care to people with intellectual disability (ID) with challenging behaviour, sometimes even without a diagnosis, than to those with a diagnosed mental illness. This is shown in a large cohort study in the United Kingdom in primary care and in a Dutch study in three residential care facilities. This prescription behaviour is undesirable. ⋯ The Dutch study showed that antipsychotic drug reduction in people with ID with challenging behaviour led to improved behaviour and improvement of physical parameters. A skilled multidisciplinary team of professionals can help with alternative management strategies for challenging behaviour. These teams should be made available for primary care services.