Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · Jan 2014
[Potential lowering of sepsis-related mortality via screening and implementation of guidelines].
The incidence of sepsis continues to increase. However, over the past decade marked reductions in sepsis-related in-hospital mortality have been reported. Large variations in the presentation and severity of illness may be encountered in ICU patients with severe sepsis, which might preclude the success of screening and guideline programmes. ⋯ In-hospital mortality did not change in 30 non-participating hospitals. Therefore, the authors recommend implementing updated guidelines, sepsis quality indicators and programmes with a package of interventions to further reduce sepsis mortality. Furthermore, additional research on long term consequences in sepsis survivors is warranted.
-
Since 2009, a warning has been issued about cocaine that has been adulterated with levamisole, mainly in the USA and Canada. Agranulocytosis occurs as an idiosyncratic reaction in 3-10% of patients exposed to levamisole. ⋯ This patient had acquired agranulocytosis, due to the use of cocaine adulterated with levamisole.
-
Ned Tijdschr Geneeskd · Jan 2014
[A medical-psychiatric unit in a general hospital: effective combined somatic and psychiatric care?].
To study the effectiveness of combined integral somatic and psychiatric treatment in a medical-psychiatric unit (MPU). ⋯ The MPU has succeeded in its goal to deliver integral care to a very diverse group of patients with somatic and psychiatric co-morbidities. It is able to offer care to a vulnerable patient group in which it can be presumed that treatment on a non-integrated unit could not have been delivered or not delivered adequately, due to the complexity of their somatic and behavioural problems.
-
Hospital standardized mortality ratios (HSMR) are meant to compare mortality risks between hospitals. There is, however, much discussion about the value of the HSMR because incomplete adjustment for case mix is almost inevitable and because the data required to estimate HSMR are often unreliable. ⋯ The number of factors that can influence mortality risk in a hospital for these 50 diagnoses is enormous. There are many potential explanations for an increased (or decreased) HSMR, meaning that even if an increased HSMR really does point towards an increased mortality risk, this provides no real indication of the underlying cause.
-
Transient global amnesia is a recognised phenomenon in adults. However in children it is rarely described. It is characterised by a sudden loss of memory in an otherwise healthy patient. What is striking is that other cognitive functions and neurological examination are normal. ⋯ Transient global amnesia may occur in childhood. Since patients recover spontaneously, watchful waiting is justified.