Nederlands tijdschrift voor geneeskunde
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Sepsis is a major cause of death worldwide. In recent years it has become clear that most septic patients do not die from an overwhelming initial pro-inflammatory immune response, but die in the subsequent immunosuppressive phase, called 'immunoparalysis', which is characterized by increased susceptibility to secondary and opportunistic infections. ⋯ Hitherto, whereas research into sepsis therapies predominantly focused on suppression of the immune system (for example with anti-cytokine therapies or glucocorticoids), recent studies increasingly concentrate on immunostimulatory treatment. Promising immunostimulatory compounds such as interferon-γ (IFN-γ) and granulocyte-macrophage colony stimulating factor (GM-CSF) have already shown promising results in experimental settings, and are currently studied in clinical trials.
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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.
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The response to the Ebola outbreak in West Africa of the governments of Guinea, Sierra Leone and Liberia, local WHO representatives, international organisations with WHO at the helm, and the international community has been much too slow. The help that is now at last being given has come much too late, and, with a few notable exceptions, it is far too little. The European Union, including the Netherlands, is distinguishing itself by its absence. It does not appear to have got through to Europe that, even if it is only in its own interest, it must offer far more help to Guinea, Sierra Leone and Liberia - and quickly.
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It has become the rule rather than the exception that junior doctors in training spend 3-4 years on a research project, culminating in a thesis. Without a PhD, clinical career prospects within and outside academia look rather bleak. Here I argue that PhD degrees should be pursued only by the most talented and motivated young clinicians.
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Ned Tijdschr Geneeskd · Jan 2014
Review[Chemotherapy-induced peripheral neuropathy; impact on quality of life].
Peripheral neuropathy is a frequently occurring side-effect of chemotherapy as a cancer treatment. The incidence of chemotherapy-induced peripheral neuropathy (CIPN) is increasing as a consequence of better treatment of cancer becoming available and increasing use of chemotherapy, and because CIPN occurs more frequently with use of new chemotherapeutics. The diagnosis 'CIPN' is made principally on clinical grounds, and it is characterized by predominantly sensory symptoms. ⋯ If CIPN occurs, the only effective strategies are dose reduction or discontinuation of chemotherapy. CIPN impairs quality of life. It is important to evaluate the symptoms of CIPN, as well as the impact on daily living.