Nederlands tijdschrift voor geneeskunde
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To map the relation between metformin prescription and renal function in an outpatient setting. To investigate whether there is an association between renal function, metformin concentration and lactate concentration. ⋯ Our study shows that in outpatient practice, the metformin dose is not sufficiently adjusted to a reduced renal function in 31% of the patients. The accumulation of metformin appears to be associated with an increased lactate concentration and a reduced renal function. Extra attention to the dose of metformin in reduced renal clearance is therefore recommended.
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Ned Tijdschr Geneeskd · Jan 2014
[Hand injuries caused by fireworks and treated by plastic surgeons].
To make an inventory of the number and nature of hand injuries caused by private firework use in the Netherlands during the New Year celebrations 2013-2014 and that were seen and treated by plastic surgeons. ⋯ The number of victims with serious hand injuries caused by fireworks was high during the New Year celebrations 2013-2014 and had increased in comparison with the preceding year. The majority of victims were aged < 18 years and were injured while setting off illegal fireworks by themselves.
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Aspiration of gastric contents during or after induction of anaesthesia can be prevented by adhering to preoperative fasting guidelines of 6 hours for solid foods and 2 hours for clear liquids. There are frequent cases in which the patient cannot be regarded as having fasted; this applies in particular to non-planned acute or semi-acute patients. Instead of postponing surgery to later the same day or even the next day, there are alternatives, such as bedside ultrasound assessment of the stomach volume or accelerating gastric emptying by administering a low dose of erytromycin. These options can contribute to a more efficient planning of surgery and a higher level of comfort for the patient.
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Ned Tijdschr Geneeskd · Jan 2014
[Accidents involving a motorized mobility scooter: a growing problem].
To analyze injury patterns, injury severity and mortality among victims of motorized mobility scooter (MMS) crashes in relation to the trauma mechanism and patient's age. ⋯ Low-energy as well as high-energy crashes involving the MMS may result in serious injuries and sometimes death. Awareness by multidisciplinary treatment teams may help to avoid underestimation of injury severity. MMS drivers need to improve their driving skills in order to reduce the number of MMS crashes.
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Ned Tijdschr Geneeskd · Jan 2014
Comment[A limited role for telemedicine on the Dutch intensive care].
The use of telecommunication and information technology has evolved rapidly in many areas. However, it has not kept pace for the organisation of medicine. It can be expected that e-Health will revolutionise the landscape of medicine in the coming years. ⋯ This cannot be compared with the Dutch situation where there are short distances between hospitals, ubiquitous, excellent infrastructure for patient transport and a sufficient number of intensivists. Furthermore, an ICU is not only characterised by its own means in terms of human resources and equipment, but also by the 24/7 availability of other (critical) medical specialities in the hospital. The contribution of tele-ICU is therefore limited in the Netherlands but might play a role for second opinions and consultation for highly specialized expertise.