Nederlands tijdschrift voor geneeskunde
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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[Revised practice guideline 'Management of patients with mild traumatic head/brain injury'].
Recently the out-of-date Dutch guideline 'Mild traumatic head/brain injury' dating from 2001 was revised under the supervision of the Dutch Institute for Healthcare Improvement (CBO). The revised guideline gives underpinned decision rules for the referral of patients to hospital, carrying out diagnostic imaging investigations, and formulating indications for admission. Mild head-brain injury is no longer an indication for a conventional skull radiograph. ⋯ The guideline can be used in both primary care and on the Emergency Departments of hospitals and is applicable to both adults and children. The guideline does not address the rehabilitation or long-term care of patients with mild traumatic head/brain injury, but it does give advice on reducing the risk of long-term symptoms. Regional implementation of the guideline in primary and secondary care is recommended.
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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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Ned Tijdschr Geneeskd · Jan 2012
Review[Appropriate and inappropriate use of indwelling urinary catheters].
Many hospitalized patients receive a urinary catheter during their stay. In 21-54% of patients, however, there is no appropriate indication for this. The most significant complication caused by the use of urinary catheters is the development of a urinary tract infection (UTI), one of the most common nosocomial infections. ⋯ The duration of the presence of a catheter is the major risk factor for catheter-associated UTI. Reducing the number of inappropriate catheterisations is an effective way of preventing catheter-related UTIs. Inappropriate use of indwelling urinary catheters can be reduced by maintaining strict guidelines on justifiable indications for inserting a urinary catheter, verifying daily whether the indication still applies, and by timely removal of the catheter when it is not or no longer needed.