Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Dec 2003
[Replacement of the femoral head due to fracture of the hip: prognostic factors for the duration of hospitalisation, institutionalisation and mortality].
To identify preoperative factors affecting length of hospital stay, residential status and mortality after replacement of the femoral head for a hip fracture. ⋯ The risk factors for a longer stay in hospital, placement in an institution or decreased survival in patients who underwent hemiarthroplasty as part of the treatment of a hip fracture can already be identified at the time of admission. The patients with these risk factors should be given special attention during the period of hospitalisation and after-care.
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Ned Tijdschr Geneeskd · Nov 2003
Review[Percutaneous dilatating tracheostomy in intensive-care patients: technique, indications and complications].
Since tracheal cannulas are increasingly used to wean intensive-care patients from respiratory machines, more doctors and nurses will find themselves having to take care of patients with tracheostomas. Indications for tracheal cannula use include the likelihood of prolonged mechanical ventilation and/or difficult weaning. Percutaneous dilatational tracheotomy is a relatively simple procedure for inserting a tracheal cannula. ⋯ When it is difficult to pinpoint the source of problems arising in patients fitted with a tracheal cannula, it must always be considered that the cannula might be the cause. Although rare, complications may arise several weeks or months after decanulation, such as stenosis of the trachea, changes in voice and fistula formation between the trachea and skin. A strict surveillance protocol is needed to recognize and treat late complication.
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Ned Tijdschr Geneeskd · Nov 2003
Review[Calprotectin: a fecal marker for diagnosis and follow-up in patients with chronic inflammatory bowel disease].
Chronic inflammatory bowel disease (IBD) is characterised clinically by periods of well being interspersed by exacerbations of disease activity. Differentiation between IBD and less severe disorders such as irritable bowel syndrome requires invasive and expensive diagnostic procedures. Diagnostic differentiation between active disease, symptoms due to residual constriction of the fibrotic lumen and functional symptoms is a well-known problem. ⋯ Disease activity was monitored by clinical symptoms, blood tests and endoscopy. Our results confirm previous literature findings that faecal calprotectin is a promising and useful non-invasive tool in the screening of patients presenting with abdominal pain and diarrhoea. Moreover, calprotectin seems helpful in differentiating between active and non-active IBD and possibly also in the monitoring of disease activity.
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A 22-year-old man with a known bipolar disorder was admitted to a psychiatric department for depression and suicidal ideation. He was being given isotretinoin to treat acne conglobata. During admission, he committed suicide. ⋯ Methodologically well-performed research is lacking. However, positive dechallenge and rechallenge cases have been reported. Consequently, physicians must look out for the onset or worsening of psychiatric symptoms in patients treated with isotretinoin.
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Ned Tijdschr Geneeskd · Nov 2003
[Evaluation and validation of a perinatal death audit by means of feedback to the caregivers].
To evaluate a perinatal audit procedure by communicating the results to the caregivers (midwives and obstetricians) involved, in order to determine whether the audit led to specific suggestions for improving practice and whether evaluation of the panel assessments by caregivers leads to a different evaluation of the audit process. ⋯ The feedback of perinatal audit results to the caregivers involved as well as discussion of these results led to specific starting points in the areas of collaboration, documentation and policymaking at both individual and institutional level.