Nederlands tijdschrift voor geneeskunde
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Mallet finger is a very common injury, but there is still much discussion about the best treatment. Mallet finger should be operated on if a fracture is larger than 1/3 of the articular surface or in volar subluxation, because otherwise the fracture may remain unstable or there may be loss of function. ⋯ Although there is no significant difference in complications between splinting and surgery, the complications of an operation may be far more serious. In spite of the current operation indication, we should be more reluctant to operate on mallet finger.
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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.
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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.
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The prevalence of morbid obesity is increasing, with a corresponding increase in the demand for bariatric surgery, a proven effective treatment option. Bariatric surgery has potentially severe complications, including micro- and macronutrient deficiencies. ⋯ Doctors in both the hospital setting and general practice will be increasingly confronted with the occasionally adverse long-term effects of bariatric surgery. Early detection, efficient follow-up and a multidisciplinary team approach are crucial in preventing and adequately treating the complications of bariatric surgery.
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Ned Tijdschr Geneeskd · Jan 2014
Review[Revised practice guidelines 'Delirium in adults and the elderly'].
A multidisciplinary workgroup has revised the 2004 practice guidelines on 'Delirium' on the initiative of the Dutch Geriatrics Society. In comparison with the previous version, the new guidelines place more emphasis on screening and non-pharmaceutical prevention and treatment. They recommend a degree of restraint when prescribing medication. ⋯ The revised guidelines consider the diagnosis and treatment of delirium as a part of basic medical care and primarily the responsibility of the attending physician. The workgroup advises consulting an expert in the field of delirium only in cases of lack of experience, and for complex cases. The guidelines also include recommendations for the organization of follow-up care for the delirium patient.