Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2011
Case Reports[When the end is near: an ICU patient who died at home].
We describe the process of transferring a 64-year-old male from a Dutch intensive care unit to his home so that he could die there. He was a respirator-dependent cardiac surgical patient; his intensive care treatment had been withdrawn. ⋯ We discuss the natural cause of death and subsequent administrative steps. Based on the positive reactions of the patient and his family, we propose to incorporate this process into Dutch intensive care practice guidelines.
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The publication of inadequately adjusted mortality rates has led to incorrect and unfair comparison of outcomes in quality of care between hospitals. In order to ensure adequate risk-adjustment of such outcomes, care providers should maintain their own registries. Such databases enable the monitoring and benchmarking of outcomes adjusted for case mix. ⋯ The goal of the database is to control and to improve the quality of care by providing frequent feedback to the participating hospitals about their risk-adjusted mortality rates. Other care providers should follow this example and register their own risk-adjusted outcomes. Such registries will function as a quality instrument and will provide an in-depth explanation of the oversimplified results that are often published.
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Ned Tijdschr Geneeskd · Jan 2011
Practice Guideline[Multidisciplinary guideline 'Heart failure 2010'].
In the multidisciplinary practice guideline 'Heart failure 2010', the diagnosis of heart failure relies on a combination of signs and symptoms and on supplementary investigation with natriuretic peptides and echocardiography. Once diagnosed, it is important to detect the potentially treatable cause of the heart failure. The non-medical treatment consists of lifestyle advice, of which regular body exercise is the most important component. ⋯ A restricted group of patients may require an internal cardiac defibrillator (ICD) and/or cardiac resynchronisation therapy. There is limited scientific evidence concerning treatment of patients with diastolic heart failure. It is important to coordinate the care of the patient with heart failure within a multidisciplinary team to provide optimal treatment and information for the patient.
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A 89-year-old woman came to the hospital with abdominal pain, vomiting and melaena. A CT-scan showed the complaints were caused by a hernia obturatoria incarcerata. After surgery the woman recovered uneventfully.
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We admitted a 43-year-old comatose man with known liver cirrhosis and hyperintense subarachnoid spaces on brain CT, suggestive of subarachnoid hemorrhage. He died shortly thereafter. Autopsy did not show signs of subarachnoid hemorrhage, but revealed extensive cerebral edema. Pseudo-subarachnoid hemorrhage due to metabolic disturbances was diagnosed.