Nederlands tijdschrift voor geneeskunde
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Energy policy and climate policy are two different issues and should not be treated as if they were the same. Whether the climate gets warmer or colder, saving energy and developing sustainable forms of energy production remain of paramount importance because fossil hydrocarbons are likely to be exhausted soon. But climate policy is a fallacy: it is human arrogance to think we can control the climate by reducing emissions and by storing CO2 underground. ⋯ Since the International Panel on Climate Change (IPCC) did not predict this, it is questionable whether they can reliably predict warming. Other factors such as solar activity are probably more important for climate than greenhouse gases. The danger of coupling energy policy to climate policy is evident: if the climate cools down, people will lose belief in the greenhouse effect and therefore also lose interest in saving energy.
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Ned Tijdschr Geneeskd · Jan 2009
[Total body CT scan as the primary diagnostic modality in multi-trauma patients].
Radiological imaging is highly protocolized during initial assessment of severely injured trauma patients. After an initial examination, radiography and ultrasound are performed. Imaging is frequently supplemented by CT scan of selective body areas. ⋯ Recent research on TBCT in multi-trauma patients shows promising results and several large European trauma centers have already protocolized this strategy. These studies lack a good study design, so more prospective research on clinical outcomes, cost effectiveness and radiation exposure is necessary. As part of a pilot study in preparation for a randomized multicenter study, the University Medical Centre in Amsterdam in the Netherlands is performing TBCT in severely injured trauma patients.
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Intensive insulin therapy for critically ill patients is implemented as standard therapy in many ICUs, even though the evidence supporting this approach comes from just two studies at a single centre. Moreover, the results could not be repeated in other multicenter trials and there is increasing evidence of a risk of hypoglycaemia. However, it appears that many intensive care specialists have been too zealous in their attempts to attain euglycemia during critical care. A recent RCT with over 6000 patients demonstrated that intensive glucose control increases mortality by 2.4%.
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Since its introduction in 1984, selective decontamination of the digestive tract has had clear supporters and opponents. De Smet et al. conducted a large national study in 13 Dutch intensive care units, investigating the effects of the following 3 regimens on mortality: standard treatment, selective decontamination of the digestive tract and selective oropharyngeal decontamination. The results showed decontamination to have a clear benefit in terms of reducing mortality. Based on these results, decontamination should be used in all intensive care patients.
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Ned Tijdschr Geneeskd · Dec 2008
[The practice guideline 'Children with fever' (second revision) from the Dutch College of General Practitioners; a response from the perspective of paediatricians].
The new version of the practice guideline 'Children with fever' was recently published by the Dutch College of General Practitioners and is commented on from the perspective of paediatricians. Whether or not general practitioners should refer feverish children to the paediatrician depends on the age of the patient and the severity of the illness. All children younger than 1 month and children with warning symptoms should be referred to a paediatrician at once. ⋯ Emphasis is put on the fact that infections are dynamic processes and therefore good follow-up is important. Children under the age of 2 years with a fever with no apparent cause should be re-examined after 24-48 h. Parents should be properly instructed to come back for re-examination of their child if the clinical picture changes or worsens.