The Netherlands journal of medicine
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Observational Study
Organisation of internal medicine in acute care in the Netherlands: a detailed overview.
Organisation of the emergency department (ED) is gaining attention due to an increased demand on emergency services, leading to crowding and influencing the quality of care. It is known that the organisation of acute care influences the performance of the ED. In the Netherlands, the organisation of EDs differs between hospitals. However, detailed information about the various organisational structures is lacking. This study aims to determine the organisational structures and the different roles and responsibilities of internists and emergency physicians (EPs) in the EDs. ⋯ This is the first study providing a detailed overview of the ED organisation in the Netherlands regarding internal medicine patients. This organisation differs in terms of staffing, presence of EPs and internists, and working agreements. The influence of the various organisational structures of EDs on quality of acute care should be the subject of future research.
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Frailty screening in the emergency department may identify frail patients at risk for adverse outcomes. This study investigated if the Dutch Safety Management Program (VMS) screener predicts outcomes in older patients in the emergency department. ⋯ In this selected group of patients, higher VMS score was associated with 90-day mortality and falls. The low positive predictive value shows that the VMS screener is unsuitable for identifying high-risk patients in the ED. The high negative predictive value indicates that the screener can identify patients not at risk for adverse medical outcomes. This could be useful to determine which patients should undergo additional screening.
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Case Reports
Spontaneous remission of unidentified Cushing's disease revealed by hair cortisol analysis.
Pituitary apoplexy is an infrequent but life-threatening complication of pituitary adenomas. When apoplexy occurs in a hormonally active adenoma, this may induce spontaneous remission of the clinical syndrome. ⋯ However, we describe a patient with Cushing's disease presenting with pituitary apoplexy, who was biochemically in remission at presentation. The diagnosis could be confirmed in retrospect using hair cortisol analysis, thereby enabling clinicians to adequately anticipate remission of Cushing's disease.
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Case Reports
Two cases of a prolonged excited delirium syndrome after chloromethcathinone ingestion.
Synthetic cathinones have become popular drugs of abuse. We describe our recent experience with two highly agitated patients following ingestion of the cathinone derivative chloromethcathinone, and cannabis. Both patients suffered from excited delirium syndromes that lasted for over 24 hours. Clinicians should be aware of this phenomenon, especially since routine toxicology screenings do not detect the presence of these agents.
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This case report describes a patient who presented with a debilitating hepatitis C virus-related cryoglobulinaemic vasculitis who was treated with immunosuppression and direct-acting antivirals. After returning symptoms revealed a relapse of the hepatitis C virus infection, treatment with direct-acting antivirals was repeated. Subsequently, he achieved a sustained virological response and his vasculitis subsided.