Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[Hip fracture in patients with dementia: surgery is not always the best alternative].
Patients with dementia are at risk of hip fracture. The prognosis of rehabilitation after surgery is less favourable than in the general population, because of higher mortality, more complications and a longer rehabilitation period. We present 2 female patients with dementia (77 and 86 years old) who each received a different therapy: one surgical, the other conservative. ⋯ When making a medical decision, it is important to consider if a treatment is effective, proportional and if the intended outcome is desirable. In some cases of hip fracture in patients with dementia, conservative treatment and withholding surgery can be good care. More investigation is needed for further evidence-based decision-making.
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Postoperative ileus is a commonly occurring complication after abdominal surgery. Reduced well-being and ileus related complications lead to extension of hospital stay. ⋯ However, these studies were small in size and of varying quality. Recently the "Chewing gum study" ("Kauwgomstudie") to investigate the effect of general use of chewing gum after abdominal surgery has been started in the Netherlands.
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Pericarditis is seen quite often in daily clinical practice. It is a condition that is fairly easy to diagnose, but which frequently recurs. ⋯ Chest pain in young people can be a symptom of pericarditis. This condition quite often recurs, but in most patients no underlying cause is revealed. Adequate medication with calcium carbasalate and colchicine reduces the chance of recurrence.
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Ned Tijdschr Geneeskd · Jan 2012
Practice Guideline[Multidisciplinary guideline 'Recognition and treatment of chronic pain in vulnerable elderly people'].
Chronic pain in vulnerable elderly people is still poorly recognized and treated, both at home and in hospitals and care and nursing homes. Vulnerable elderly people experience and express pain differently to relatively healthy adults, especially when they suffer from cognitive impairment or specific conditions. Determining the nature and severity of the pain requires the use of pain assessment instruments that have been validated for use in vulnerable elderly people. ⋯ The combination of multiple morbidity and poly-pharmacy increases the chance of side-effects and complications. In addition, the pharmacokinetic and pharmacodynamic characteristics of many drugs are different in vulnerable elderly people. The advice is to start with a lower dose of pain medication and gradually build up a level on the basis of pain relief and side-effects ('start low, go slow!').
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A 67-year-old man presented in the emergency department after a fall on his outstretched right hand. Physical examination showed tenderness of the anatomical snuffbox and the dorsal side of the wrist. X-rays of the wrist revealed a perilunate luxation combined with a scaphoid fracture.