Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Aug 2020
[The Netherlands Triage Standard applied to paediatric patients in emergency medicine: is it reliable and valid?]
To determine the inter-rater reliability and validity of the Netherlands Triage Standard (NTS) for paediatric triage. ⋯ The results of the study contribute to the evidence that the NTS is a reliable and valid triage standard for paediatric patients. The urgency assessments by triagists in the GP out-of-hours practices, ambulance dispatching centres and hospital emergency departments were broadly in agreement. Results were limited by cases being on paper and triage only on anamnestic characteristics.
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Over the past few months, regular care has been postponed where possible in order to increase the healthcare capacity for COVID-19 patients. The pressure imposed on the healthcare system by the new coronavirus has led to the need for the prioritising of breast cancer care. ⋯ In certain groups of patients, including those with ductal carcinoma in situ or an endocrine sensitive tumour, treatment may be postponed or modified, although with certain reservations. At the initiative of the NationaalBorstkankerOverleg Nederland, prospective data are currently being collected in order to gain more insight into the impact of COVID-19 on breast cancer care.
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Ned Tijdschr Geneeskd · Jul 2020
Case Reports[Progression of dyspnea in COVID-19 patients: now what?]
Venous thromboembolism (VTE) seems to be an underdiagnosed complication in COVID-19 patients. We present three male patients, aged 67, 29 and 71 years, who were admitted to the hospital with COVID-19. They all showed deterioration in the course of their disease caused by VTE. ⋯ Deterioration in the course of COVID-19 has differential diagnoses such as progression of the infection itself, secondary bacterial pneumonia, left heart failure and in our experience not infrequently VTE. We therefore recommend to consider VTE in COVID-19 patients with a sudden clinical deterioration such as hypotension, tachycardia, unexplained hypoxaemia or insufficient clinical improvement and to perform CT-angiography if indicated. A high dose of thromboprophylaxis in COVID-19 patients may be considered because of increased coagulation activation.
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Ned Tijdschr Geneeskd · Jun 2020
Observational Study[The role of children in the transmission of SARS-CoV-2].
To determine whether children play a role in the transmission of SARS-CoV-2 to other children and adults, and to gain insight into symptomatic and asymptomatic infections in children. ⋯ The study gives no indications that children play an important role in the transmission of SARS-CoV-2. Children can indeed become infected, but transmission mainly takes place between adult peers and from adult family members to children. Transmission among children or from children to adults, as is known in influenza, appears to be less common. Ongoing studies should provide important information for further decision-making on control measures, such as closure of schools.
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Ned Tijdschr Geneeskd · Jun 2020
[Hydroxychloroquine and chloroquine for COVID-19: no evidence of effectiveness].
On 3 March 2020, the document 'Drug treatment options for patients with COVID-19 (infections with SARS-CoV-2)' was published on the website of the Dutch Working Party on Antibiotic Policy (StichtingWerkgroepAntibioticabeleid, SWAB). Based on a 7-step analysis of the literature, hydroxychloroquine (HCQ) and chloroquine (CQ) were initially included in the SWAB document as possible drug treatments for hospitalised adult COVID-19 patients. ⋯ On the basis of these results, we conclude that there is insufficient evidence to consider HCQ and CQ as meaningful treatment options in patients with COVID-19. Clinically relevant QTc prolongation occurs in at least 1 in 10 COVID-19 patients treated with HCQ or HQ.