Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jun 2008
[Fewer caesarean sections for breech presentation following external cephalic version according to a protocol in a special office visit].
Identification of determinants affecting the outcome of external cephalic version (ECV) in breech presentation, and investigation of the impact of ECV--performed according to a standardized protocol in an outpatient clinic--on the mode of delivery. ⋯ A regular team consisting of a hospital midwife and a gynaecologist working according to a standardized protocol for ECV in a case of breech presentation proved successful: the number of term breech presentations substantially diminished and therefore the percentage of caesarean sections was lower in the group in which ECV had been successful. This could have considerable impact on health care in the Netherlands in terms of reduced maternal morbidity and cost savings.
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In both 2006 and 2007 a large operating room fire occurred in the Netherlands. One patient died as a result of a sudden intense flash fire caused by a leaking oxygen connection. Smaller operating room fires can cause severe burn injuries and inhalation trauma in patients. ⋯ Inflammable substances and ignition sources, such as a diathermic knife or laser, may be present in the operating theatre and environs. The combination of these 3 components (fuel, oxygen and ignition) increases the risk of operation room fires. Prevention and control of this hazard depends on removal of one or more of the 3 components.
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Ned Tijdschr Geneeskd · May 2008
[The effect of specialised medical procedures on the hosptial standardised mortality ratio in cardiac centers].
To examine the impact of specialised medical procedures (SMPs) on the hospital standardized mortality ratio (HSMR) in Dutch cardiac centres. ⋯ Specialised medical procedures for heart conditions influence the HSMR of cardiac centres. The increase or decrease in HSMR is related to the relative frequency of PTCA and open heart surgery. These results can be used to help interpret the differences in HSMR among cardiac centres and other hospitals.
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Ned Tijdschr Geneeskd · May 2008
Review[Medicine is not gender-neutral: influence of physician sex on medical care].
Many studies have shown that men and women differ in communication styles. The question is whether these differences also play a role during medical consultation. Potential differences between male and female physicians that have been investigated, are differences in doctor-patient communication, the diagnostic process and treatment. ⋯ Within the medical profession, male and female medical students are socialised differently, and professional socialisation does not overcome differences in gender roles. Patients are generally more satisfied with female physicians than male physicians. Knowledge of and insight into these processes is essential for improving the quality of care.
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Ned Tijdschr Geneeskd · May 2008
[Diagnosis and treatment of patients with spinal epidural metastases].
Three patients with a medical history of malignancy were referred for back pain: two women aged 53 and 43 years respectively, with breast cancer, and a woman of 85 years with rectal carcinoma. All patients suffered from spinal metastasis. Considerable delay occurred between the initial complaint of back pain and the diagnosis. ⋯ A reliable differentiation, based on symptoms and signs, between widely occurring non-malignant back pain and back pain due to spinal metastasis is impossible. This confronts physicians with the dilemma of overexposing their patients to diagnostic tests on the one hand and the risk of missing an important diagnosis on the other. Early recognition of warning signs, i.e. previous medical history of malignancy, onset of back pain above 50 years of age, continuous pain not related to posture or movement and nocturnal pain, should alert physicians.