Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2011
Review[Physical examination of patients with acute abdominal pain].
Reliable physical examination of patients presenting with acute abdominal pain and tenderness is necessary for identifying serious causes on the one hand, and for preventing further unnecessary imaging on the other. If acute appendicitis or peritonitis is suspected, positive palpatory findings like rigidity and guarding are helpful diagnostic indicators, whereas negative palpatory findings have little value in excluding these conditions. ⋯ Visible peristalsis strongly argues for small bowel obstruction, but this sign is rarely present. Digital rectal examination appears to have no added diagnostic value for appendicitis, peritonitis, or small bowel obstruction.
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Ned Tijdschr Geneeskd · Jan 2011
Comparative Study[Hospital standardised mortality ratio (HSMR): adjustment for severity of primary diagnosis can be improved].
To study the impact of casemix variations within primary diagnostic groups on hospital standardised mortality ratios and to improve the current HSMR model. ⋯ The HSMR model currently used in the Netherlands does not adequately adjust for casemix differences at the level of ICD-9 primary diagnoses. A model using a severity classification of ICD-9 codes based on actual Dutch hospital mortality allows for a better, albeit not perfect, adjustment. We recommend implementation of the 'Dutch' severity classification in order to improve the HSMR model.
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Effective intra-operative anaesthesia and peri-operative analgesia are important aspects of patient care in orthopaedic surgery. The interscalene regional anaesthetic block technique, performed with the patient lying in a lateral decubitus position, is new for arthroscopic shoulder surgery conducted in the Netherlands. The combination of the interscalene block (without general anaesthesia) and the lateral decubitus position results in better peri-operative conditions for the patient. Better analgesia, increased patient satisfaction and fewer complications in comparison to general anaesthesia have been reported for these types of surgery.
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Ned Tijdschr Geneeskd · Jan 2011
Case Reports[Imminent respiratory insufficiency in children resulting from Guillain-Barré syndrome].
Early recognition of Guillain-Barré syndrome (GBS) is crucial to anticipate and adequately respond to possible respiratory insufficiency. Young children with GBS frequently have non-specific complaints and are more difficult to examine, which may cause a significant delay in diagnosing GBS. ⋯ Young children with GBS often present with pain and refusal to walk, or with difficulty swallowing, and are often initially misdiagnosed with e.g. tonsillitis or coxitis. These nonspecific symptoms can be a first sign of a progressive polyradiculoneuropathy and should prompt a full neurological examination and timely referral to a paediatric neurological centre with Intensive Care facilities.
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Ned Tijdschr Geneeskd · Jan 2011
[Rapid response system in derangement of vital signs: five years experience in a large general hospital].
Hospitalized patients are at risk for adverse events such as unexpected cardiac arrest or admission to an Intensive Care Unit (ICU). Prior to these adverse events these patients often have derangements in vital signs that are not recognized and treated adequately. To identify and treat those patients at risk, our hospital implemented a rapid response system in 2004. The purpose of this paper is to describe implementation and results of our rapid response system. ⋯ In our hospital the rapid response system has developed into an important tool for the early identification and treatment of patients at risk. However, our data cannot prove the efficacy of the rapid response system in terms of reducing hospital mortality.