Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2013
Comparative Study[The simulated setting for testing competencies; task shifting in outpatient anaesthesia].
Pre-anaesthesia evaluation is a complex task requiring integration of information obtained from the patient's history, physical examination and the proposed surgery. This task, traditionally performed by physicians, is increasingly being executed by specialised nurses or physician assistants in daily practice. ⋯ Simulation to test competencies requires properly described competencies within an adequate and validated simulation model, a suitable and validated assessment system, and an understanding of the causes of errors in measurement. A simulation study with an adequate sample size to detect a given sensitivity of physician assistants of 80% to identify significant comorbidity during pre-anaesthesia evaluation would require simulation of 1,000 to 1,500 consults.
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Ned Tijdschr Geneeskd · Jan 2013
Comment[New practice guideline for spine related low back pain; anesthesiologists use a different classification system than general practitioners].
The practice guideline 'Invasive treatment of spine related low back pain' was recently released by the Netherlands Society of Anesthesiologists. This guideline evaluates the state of the art regarding the diagnosis and value of invasive treatment for facet joint pain, pain in the sacroiliac joint, coccygodynia, discogenic pain and the 'failed back surgery syndrome'. ⋯ The guideline was created in a methodologically sound manner, but the results are disappointing: the evaluated diagnoses remain disputable and the recommendations for the evaluated treatments are mostly based on expert opinion. The guideline lacks information on the scientific basis of the proposed new classification system, which makes its clinical usefulness questionable.
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Ned Tijdschr Geneeskd · Jan 2013
Case Reports[Carbon monoxide poisoning after smoking from a water pipe].
Smoking from a water pipe has become increasingly popular, but this is not as innocent as it seems. ⋯ The regular or even one-time use of a water pipe containing tobacco or an aromatised substance can cause CO poisoning. Patients can continue to experience symptoms for weeks after an episode of acute CO poisoning.
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Ned Tijdschr Geneeskd · Jan 2013
Case Reports[Unexpected abdominal trauma from a fireworks explosion].
Fireworks injuries are common and often affect children. Such injuries should be considered high energy trauma in the emergency room and taken care of according to the principles of the Advanced Trauma Life Support (ATLS). ⋯ Potentially life threatening injuries may accompany hand injuries after modern illegal fireworks. Hand injuries are serious. Despite prolonged treatment, they often result in permanent disability. The structured approach to trauma according to ATLS was important in detecting an accompanying abdominal trauma in this case.
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Ned Tijdschr Geneeskd · Jan 2013
Case Reports[Tracheal rupture as a cause of unanticipated perioperative mortality].
Here we report two cases in which healthy young patients died during surgery because ventilation was impossible by a clinical picture of massive subcutaneous emphysema. The probable diagnosis was tracheal rupture. This diagnosis was not confirmed during coroner's autopsy, but there had been no systematic search for a puncture in the trachea or the main bronchial tubes. Immediate recognition of this situation, and implementation of ventilation of one lung by pushing a narrower endobronchial tube beyond the tracheal rupture, is potentially life-saving.