Nederlands tijdschrift voor geneeskunde
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A 4-year-old boy visited the emergency department with a painful foot. We diagnosed osteochondrosis of the tarsal navicular, also known as Köhler's disease. The patient was successfully treated with a plaster bandage for 4 weeks.
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Ned Tijdschr Geneeskd · Jan 2010
[Guideline on responsible teamwork: don't let it become a manacle].
The recently published guideline entitled 'Division of responsibility in teamwork within the care sector' was developed on the request of the Dutch Health Care Inspectorate. Its aim is to ensure that in a teamwork situation in the care sector proper agreements are made concerning the responsibilities of the care providers who work together. ⋯ The document does not reflect everyday practice, but an abstracted theoretical situation, in which the patient, nurse and doctor are indicated using terms such as 'subject expert', 'client', 'care professional' and 'contact'. The document emphasizes responsibilities strongly, but the quality of health care could perhaps be better served by the motivation of caregivers to provide the best possible care.
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Ned Tijdschr Geneeskd · Jan 2010
[Vertebroplasty: a treatment option for osteoporotic compression fractures].
Percutaneous vertebral augmentation, with percutaneous vertebroplasty (PVP) as its most widely used variant, is currently the only intervention for painful osteoporotic compression fractures. This procedure offers immediate and substantial pain relief in over 80% of treated patients with a low reported complication rate (< 1.6%). A large number of studies have shown promising results and the superiority of this treatment over conservative treatment has been established. ⋯ Limitations in the design of both trials prevented widespread implementation of the results. We believe that PVP cannot be regarded as an obsolete treatment as long as patients are carefully selected. Patients with persistent (over 2 months) and painful osteoporotic vertebral fractures have been shown to benefit from vertebroplasty and are therefore suitable candidates for this procedure, which, in these cases, can prevent complications due to long-term disabling pain.
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The Dutch parliament has recently accepted a tax law in which certain groups of alternative therapists can be exempt from VAT. To be eligible for this VAT exemption, the disciplines to which the therapists belong have to meet certain training requirements. ⋯ It legitimizes harmful therapies. This is illustrated by two serious accidents, previously described in this journal, caused by a chiropractor and a craniosacral therapist.
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Ned Tijdschr Geneeskd · Jan 2010
Case Reports[Unexplained fever after exposure to rats: rat bite fever or Haverhill fever].
A 24-year old man presented himself to the emergency ward with complaints of fever, nausea, headache, muscle ache and chest pain. Two weeks before presentation he had been bitten by a pet rat. We determined that he had bacteraemia caused by a Streptobacillus moniliformis infection, which led to the development of an illness called rat bite fever. ⋯ It is the cause of two similar illnesses: rat bite fever and Haverhill fever. Clinicians should consider these infections in the work-up of unexplained fever or sepsis, certainly in the presence of known exposure to rats. Treatment consists of antibiotics.