Nederlands tijdschrift voor geneeskunde
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A large population-based cohort study by Gharbi et al. found an association between deferred or no antibiotic prescribing in patients with a urinary tract infection (UTI) or suspected UTI and an increased incidence of bloodstream infections and all-cause mortality. The study concludes that early initiation of antibiotics in (high risk) elderly is recommended. ⋯ Critical appraisal of the study, however, reveals several arguments that challenge the clinical relevance of the findings; a nuanced interpretation of this study's conclusion is therefore indicated. Altogether, current guidelines for elderly with UTI provide sufficient standards for safe care, since they emphasize that holding back antibiotics should be combined with a careful watchful waiting policy and adequate safety net advice.
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Ned Tijdschr Geneeskd · Aug 2019
Review Case Reports[Penetrating neck injury caused by stabbing: a rare but complex problem in the Netherlands].
Penetrating neck injuries (PNIs) as a result of stabbing or deliberate self-harm are complex and potentially life-threatening. Nowadays, selective non-operative management of PNI has become common practice. Diagnostic and treatment algorithms originating from high-volume trauma centres in South-Africa and North-America are used in Dutch clinical practice. ⋯ One patient, aged 57, was haemodynamically unstable and therefore received immediate surgical exploration of the neck. A penetrating injury of the jugular vein was discovered and repaired. A summary of literature and guidelines is presented for the benefit of Dutch physicians that may be confronted with these complex injuries.