Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2015
Case Reports[Oculocardiac reflex associated with orbital floor fracture; the value of a reliable patient history].
The oculocardiac reflex presents when traction is applied to ocular muscles or on compression of the eyeball in the orbit. It is a vasovagal reaction that may be accompanied by bradycardia, nausea and vomiting. ⋯ When patients present with acute pain in the eye and vasovagal symptoms, the oculocardiac reflex that can accompany a fracture of the orbital floor should be considered. The early recognition and treatment of this fracture are necessary to prevent permanent motility restrictions of the eye. A patient's history is not always reliable and should not limit a differential diagnosis.
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A 41-year-old man visited his general practitioner because of upper abdominal pain. Physical examination revealed splenomegaly. Laboratory testing showed pancytopenia with a striking monocytopenia with hairy cells. Immunological and molecular analysis confirmed the diagnosis hairy cell leukemia.
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Ned Tijdschr Geneeskd · Jan 2015
Case Reports[Catecholaminergic polymorphic ventricular tachycardia; possible diagnosis in cases of syncope and sudden death of family members].
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited cardiac arrhythmia syndrome. CPVT is characterised by polymorphic ventricular arrhythmias induced by exercise or emotion. These arrhythmias may lead to sudden death. ⋯ CPVT should be considered in young patients who present with syncopal episodes during exercise or emotions, or who display polymorphic ventricular arrhythmias. Family history can also be indicative, particularly if family members have died suddenly at a young age under similar circumstances.
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Ned Tijdschr Geneeskd · Jan 2015
[Situational awareness: you won't see it unless you understand it].
In dynamic, high-risk environments such as the modern operating theatre, healthcare providers are required to identify a multitude of signals correctly and in time. Errors resulting from failure to identify or interpret signals correctly lead to calamities. Medical training curricula focus largely on teaching technical skills and knowledge, not on the cognitive skills needed to interact appropriately with fast-changing, complex environments in practice. ⋯ Improving situational awareness in high-risk environments should be part of medical curricula. In addition, the flood of information in high-risk environments should be presented more clearly and effectively. It is important that physicians become more involved in this regard.
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Ned Tijdschr Geneeskd · Jan 2015
[Criticism of evidence-based medicine: from reductionism to realism in the application of guidelines].
This article discusses recent criticism of evidence-based medicine (EBM), which has tended to place unilateral emphasis on evidence originating from randomised trials into effectiveness. The goal of the pioneers of EBM, however, was actually the application of scientific evidence to the individual patient, including the doctor's experience ('practice-based') and the patient's preference ('preference-based') in decision making. ⋯ The application of guidelines should not involve pursuit of 'standard care' but, primarily, the pursuit of shared decision making. This could lead to 'real EBM', in which medical knowledge is translated to practical choice options from different perspectives.