Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
[Dutch national safety programme will not lead to a fifty per cent reduction in avoidable mortality in hospitals].
Progress in improving patient safety in hospitals has been frustratingly slow, for several reasons. There are, for example, few proven effective improvement interventions available. Evaluation of the effectiveness of safety interventions is complicated by the complexity and variability of these interventions due to local differences and preferences of care providers. ⋯ Also, problems experienced by care providers when implementing safety interventions are not being systematically addressed. For these reasons, the aim of the Dutch national safety programme in hospitals - to reduce the incidence of avoidable harm by 50% in 5 years - will not be feasible or measurable. It is necessary to identify effective safety interventions and to exchange experiences in successful implementation of these in order to support care providers in improving patient safety.
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Postoperative pain management is an essential part of surgical management. In the Netherlands paracetamol, NSAIDs and, if necessary, opioids are the most commonly used drugs for perioperative analgesia. Metamizole is a non-opioid analgesic that is rarely used in the Netherlands, although it is one of the most frequently used analgesics around the world. ⋯ Its mechanism of action is still under discussion, but the main action is likely to be an inhibition of prostaglandin synthesis in both peripheral tissues and the central nervous system. Based on the current literature, metamizole deserves a role in the management of post-operative pain in the Netherlands. It seems to be a safe and effective drug for acute pain management especially when compared with NSAIDs.
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Ned Tijdschr Geneeskd · Jan 2012
Randomized Controlled Trial Multicenter Study[Direct total body CT scan in multi-trauma patients].
Immediate total body computed tomography (CT) scanning has become important in the early diagnostic phase of trauma care because of its high diagnostic accuracy. However, literature provides limited evidence whether immediate total body CT leads to better clinical outcome then conventional radiographic imaging supplemented with selective CT scanning in trauma patients. The aim of the REACT-2 trial is to determine the value of immediate total body CT scanning in trauma patients. ⋯ The REACT-2 trial is the first multicenter randomized clinical trial that will provide evidence on the value of immediate total body CT scanning during the primary survey of severely injured trauma patients.
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Ned Tijdschr Geneeskd · Jan 2012
Review[Eosinophilic oesophagitis: a frequently missed cause of dysphagia].
Oesophageal dysphagia is the subjective feeling that there is a problem with the passage of solids or liquids through the oesophagus. The differential diagnosis of dysphagia is long and can be divided into mechanical and motility disorders. Dysphagia is an alarming symptom which requires short-term endoscopic evaluation. ⋯ The typical eosinophilic oesophagitis patient is a young adult man, often with an atopic constitution, who has intermittent symptoms of dysphagia. The diagnosis of 'eosinophilic oesophagitis' is based on characteristic histological findings in the oesophagus, seen in a fitting clinical context. Best evidence for the effects of treatment of eosinophilic oesophagitis is available for topical glucocorticoids.
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Measurement of cardiac troponins (cTnT and cTnI), the only cardiac specific biomarkers available, is the gold standard in diagnosing acute coronary syndrome. Due to the recent introduction of more sensitive methods i.e. the high-sensitivity troponin assays, the diagnostic cut-off concentrations have very recently been established. We describe two male patients who presented at the emergency department with acute chest pain, but in whom clear evidence for a myocardial infarction in the ST segment of the EKG was lacking. ⋯ Case 2 shows that the diagnosis of acute myocardial infarction should be accompanied by a typical rise or fall of troponin concentrations. The latest insights into high-sensitivity cardiac troponin assays are discussed in this article. We focus specifically on sensitivity and specificity, reference values obtained from a healthy control group, and the reference change value required to detect acute myocardial infarction.