The Netherlands journal of medicine
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Decision-making in older persons with end-stagebkidney disease (ESKD) regarding dialysis initiation is highly complex. While some older persons improve with dialysis and maintain a good quality of life, others experience less benefit and multiple complications due to a high morbidity burden and (early) mortality. ⋯ Therefore, the aim of this review is to give healthcare providers an insight into the existing literature on geriatric impairments in older persons with ESKD. Furthermore, specific areas of concern will be discussed, in combination with some practical advice.
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The current Covid-19 outbreak poses many challenges on hospital organisation and patient care. Our hospital lies at the epicentre of the Belgian epidemic. ⋯ This demanded an unprecedented adaptation of our hospital organisation, and we have met many clinical issues in the care for Covid-19 patients. In this article, we share our experience in the handling of some of the practical and organisational issues in the care for Covid-19 patients.
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Point-of-care ultrasound (POCUS) is gaining interest in intensive care medicine and good reviews and guidelines on POCUS are available. Unfortunately, how to implement POCUS and practical examples how to train staff and junior doctors is not well described in literature. We discuss the process of POCUS implementation, and a POCUS training program for residents prior to their intensive care rotation in a Dutch teaching hospital intensive care unit. ⋯ Theoretical tests are taken shortly before, on the last day of the course, and after three months to assess learning retention. Practical tests are taken on the last day of the course and after three months. We stress the importance of POCUS for intensive care and hope that our experiences will help colleagues who also want to go forward with POCUS.
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Hyponatraemia due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) can pose a therapeutic challenge. After fluid restriction, urea is recommended as a second-line treatment by Dutch and European treatment guidelines. Data on this practice are still scarce. We introduced urea for the treatment of SIADH in our hospital and prospectively collected data on its effectiveness and tolerability. ⋯ Our data show that urea is an effective treatment for hospitalised patients with SIADH. Distaste was a frequent side effect, but usually did not lead to early treatment discontinuation.