Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · May 1999
Practice Guideline Guideline[Guideline for administration of sedatives and analgesics by physicians who are not anesthesiologists. National Organization for Quality Assurance in Hospitals].
A consensus text for sedation or analgesia in diagnostic or therapeutic procedures has been developed for application by non-anaesthetist physicians. The final consensus text has the support of 17 scientific societies in the Netherlands. There is not enough medical manpower for direct, personal, specialist-based supervision of level 3 sedation procedures (the patient is relaxed, with eyes closed, but promptly reacts to verbal commands) for significant number of patients in the Netherlands. ⋯ The consensus party favours titrated administration of small doses of short acting sedative or analgetic drugs. Combining sedative and analgesic drugs increases risk. Sedation and analgesia in children and patients with mental handicaps is acceptable in terms of quality, but requires special expertise, because of the greater psychic and physical vulnerability of these categories of patients.
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Ned Tijdschr Geneeskd · Apr 1999
Practice Guideline Guideline[Physician-assisted suicide for a patient with a psychiatric disorder: guidelines for psychiatrists. Dutch Association of Psychiatry].
In September 1998, the Dutch Association of Psychiatry published guidelines for the psychiatrist concerning cases of psychiatric patients requesting assistance with suicide. Assistance with suicide is restricted to a psychiatrist in his role as a treating physician of a patient with a psychiatric disorder. Requests for assisted suicide should primarily be considered as requests for help with life. ⋯ In addition an independent psychiatrist should be consulted as well as former treating physicians, general practitioner, family members and other people involved. If a somatic specialist or a general practitioner is asked to assist in suicide consultation of two psychiatrists is required. The guidelines offer psychiatrists a framework for taking great care when their patients request assisted suicide and will certainly play a part in the legal control of assisted suicide.
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Ned Tijdschr Geneeskd · Mar 1999
Review[Selective decontamination of the digestive tract reduces mortality in intensive care patients].
Selective decontamination of the digestive tract (SDD) is a strategy designed to prevent or minimize the impact of infections by potentially pathogenic micro-organisms in critically ill patients requiring long-term mechanical ventilation. SDD is a four-component protocol to control the three types of infections occurring in intensive care patients: (a) a parenteral antibiotic, cefotaxime, for a few days to prevent primary endogenous infections that generally occur 'early'; (b) the topical antimicrobial drugs colistine (polymyxin E), tobramycin and amphotericin B (together: PTA) used throughout the stay in the intensive care unit (ICU) to prevent secondary endogenous infections developing in general 'late'; (c) a high standard of hygiene to prevent exogenous infections that may occur throughout the ICU stay; (d) surveillance samples of throat and rectum to distinguish between the three types of infection, to monitor compliance and efficacy of treatment and to detect emergence of resistance at an early stage. ⋯ It failed to detect any report on the emergence of resistance and associated superinfections and/or out-breaks in the 33 studies covering a period of more than 10 years. Using the criterion of cost-per-survivor, four recent randomised trials showed that it is cheaper to produce a survivor using SDD than with the traditional approach.
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Ned Tijdschr Geneeskd · Mar 1999
Practice Guideline Guideline[Optimizing the antibiotics policy in the Netherlands. IV. SWAB- guidelines for antimicrobial therapy of adults with sepsis in hospitals. Foundation Antibiotics Policy Work Group].
The Stichting Werkgroep Antibioticabeleid (SWAB, Foundation Antibiotic Policy Team) issued guidelines for empirical antimicrobial therapy in the hospital of sepsis in adults. A distinction is made between sepsis in patients with and patients without neutropenia. ⋯ The use of antibiotics with a very broad spectrum, like carbapenems and piperacillin-tazobactam, or antibiotics which can be applied in infections with microorganisms difficult to treat, like quinolones and glycopeptides, is limited in the empirical treatment of sepsis in order to combat development of resistance. It is crucial to streamline antibiotic therapy as soon as the causative agent of the sepsis is known; this includes choosing an antibiotic with the narrowest possible spectrum.