Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2010
[Delirium on intensive care frequently missed: clinical impression alone is not enough].
To compare the sensitivity and specificity of a routine assessment (clinical impression) with a structured assessment which uses a validated assessment scale for the recognition of delirium on the intensive care unit (ICU). ⋯ The diagnosis delirium is frequently missed on the ICU when only based on clinical impression. Routine assessment using a validated assessment scale such as the CAM-ICU might possibly improve this.
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Ned Tijdschr Geneeskd · Jan 2010
['Advanced triage' improves patient flow in the emergency department without affecting the quality of care].
To investigate whether 'advanced triage' improved patient flow among self-referred patients in the emergency department of a level 1 trauma centre and, most importantly, whether the quality of medical care was maintained. In advanced triage, the triage nurse initiates additional diagnostic investigations independently. ⋯ The implementation of advanced triage improved patient flow for self-referred patients in the emergency department without affecting the quality of medical care. Advanced triage was successful in the Dutch system, too.
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Ned Tijdschr Geneeskd · Jan 2010
Case Reports[Severe metabolic acidosis as a result of 5-oxoproline in acetaminophen use].
Acetaminophen overdose is a well known cause of liver function disorder and even hepatic failure. Less well known is that even a therapeutic dose of acetaminophen may lead to life-threatening problems. ⋯ A systematic approach can help us to determine the cause of a high anion gap metabolic acidosis. In unexplained high anion gap acidosis clinicians should consider the possibility of 5-oxoproline accumulation in patients with risk factors such as acetaminophen use, female sex, malnutrition, infection, diminished liver function or renal failure.
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Appendicitis was first recognised by the American surgeon Fitts in 1886. Three years later, the New York surgeon Charles McBurney (1845-1913) described the location of greatest pain in this condition: '... between an inch and a half and two inches from the anterior spinous process of the ilium on a straight line drawn from that process to the umbilicus'. He also advocated early surgical treatment and described a variety of surgical techniques.