Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Apr 2003
[Asylum seekers in the Pacific Ocean: high prevalence of psychiatric disorders due to camp conditions].
Australia deports its asylum seekers to poor neighbouring islands like Nauru in the Pacific. The asylum seekers are kept in detention on these islands, with serious consequences for their mental health and a high incidence of psychiatric disorders. ⋯ Detention is unnecessary and inhumane. The International Organization for Migration, responsible for running these camps, should reconsider its mission as the world's leading organisation for migration issues.
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Ned Tijdschr Geneeskd · Apr 2003
Review[New developments in the treatment of nausea and vomiting caused by chemotherapy].
With the advent of the 5HT3-receptor antagonists in the 1990s and their combination with dexamethasone, complete emesis protection during the first 24 hours after administration of an emetogenic cytostatic agent became possible in 70% of the patients. Despite acute emesis protection through the use of 5HT3-receptor antagonists and dexamethasone, 40% of the patients do have symptoms during the following days. 5HT3-receptor antagonists and dexamethasone are modestly effective in this delayed phase and the antiemetic protection decreases progressively with multiple cycles. ⋯ The effectiveness of this triple therapy is sustained during subsequent cycles. The chance that an individual patient will be completely protected from severe nausea and vomiting during the entire course of chemotherapy (often 6 cycles) consequently increases significantly (from 34% in the placebo group to 59% in the aprepitant group).
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Ned Tijdschr Geneeskd · Apr 2003
Case Reports[Diagnostic image (134). A woman with a crepitating arm. Post trauma emphysema].
A 35-year-old woman presented with extensive subcutaneous emphysema caused by trapping of air by valve-like wound edges after a minor trauma of her right olecranon.
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Ned Tijdschr Geneeskd · Apr 2003
Case Reports['Tired of life': a reason to evaluate physical handicaps].
A 91-year-old woman was admitted to a nursing home because of functional deterioration: poor vision and hearing, and diminished mobility. She had been widowed for 30 years, had no children and a very small social network. She described herself as 'tired of life', and alluded to the assisted suicide of the former senator Brongersma, where this term was the trigger to the administration of assistance. ⋯ The term 'tired of life' appears to be rather confusing, as it has no medical connotation. It is recommended that elderly persons who ask for help in dying because they are 'tired of life', based on physical handicaps, are evaluated carefully to determine the severity of the handicaps and the hopelessness and unbearableness of the suffering. This could lead to the patient receiving assistance in dying.
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About 15% of hospital admissions of elderly patients in the Netherlands are caused by adverse effects of drugs. With polypharmacy there is an increased chance of adverse effects occurring. It is not always possible to reduce polypharmacy in the elderly. ⋯ The most important pharmacodynamic changes in the elderly concern an increased sensitivity of the target organ. This is particularly the case for substances which have an effect on the central nervous system, such as antidepressants and antipsychotics, but also applies to benzodiazepines, coumarin derivatives and digoxin. When an unexpected adverse effect occurs in a patient or a previously effective therapy suddenly fails, it is wise to consider drug interaction as a possible cause.