Medicina intensiva
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To determine if permanent pacemaker implants (PPM) interventions and change of generator are more efficient in small hospitals. ⋯ Pacemaker implantation and generator change in small hospitals is more efficient, with internal consistency by subgroups.
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Abroad, but also in The Netherlands, there are many misunderstandings concerning end of life decisions and euthanasia. In general, euthanasia does not play any role in the intensive care units, simply because it does not fulfill the conditions to carry it out. However, there is still confusion, merely due to the assumption that the Dutch situation is different because of their legislation on euthanasia. ⋯ Collecting all necessary information including the wishes and will of the patient, medical expertise and acknowledging limitations of medical treatment will help to determine futility of treatment goals. Once it is determined that surviving the intensive care unit with a quality of life acceptable for the patient is beyond reach, the goal of treatment should be improved and the dying process optimized. Stopping a treatment modality at the request of a will-competent patient or because of futility is not euthanasia.
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Letter Case Reports
[Pneumorrhachis: a rare complication of an asthma episode].
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The presence of microorganisms with acquired resistance to multiple antibiotics complicates the management and outcome of critically ill patients. The intensivist, in his/her daily activity, is responsible for the prevention and control of the multiresistance and the challenge of prescribing the appropriate treatment in case of an infection by these microorganisms. ⋯ We also present data on the situation in our country known primarily through the ENVIN-UCI register. Addressing the multiresistance not only requires training but also teamwork with other specialists and adaptation to the local environment.