Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2015
Review[Does it still make sense? Deprescribing in the frail elderly].
Elderly patients with multimorbidity often take several chronically used medicines. A large part of this polypharmacy is preventive in intention. Although one would expect that, at the end of life, the ratio of preventive therapy, would decrease in proportion to symptomatic treatment, this appears often not to be the case in practice. ⋯ One of the major reasons for this is uncertainty about the potential clinical consequences of deprescribing. Since frail elderly people seldom participate in clinical drug trials, clear information is not available for this patient group on the balance between the chance of efficacy and the risk of harm of drug therapy. Discussion with the patient about his or her preferences and options with respect to drug therapy is the basis for all subsequent steps and must form part of the periodic reviews of medication.
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Ned Tijdschr Geneeskd · Jan 2015
[Cognitive aid for emergencies in the OR--AMC bundle helps ensure that no steps are left out].
Crucial management steps in unexpected perioperative emergencies are frequently omitted by OR teams because of the suboptimal performance of the brain under stress. A cognitive aid is a tool that will help care providers to perform and speed up all the necessary management steps of a critical event. ⋯ Their use has furthermore, been standard practice in other high-risk industries for many years. Further research should therefore mainly focus on the implementation and optimisation of these tools.
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The refeeding syndrome may occur during reintroduction of carbohydrates in malnourished patients. This syndrome is characterized by reduced plasma electrolyte levels, hypophosphataemia being most prevalent. The symptoms can vary from minor symptoms to severe neurological or cardiac symptoms. ⋯ Currently, there is no single definition of this syndrome and therefore there is no solid scientific basis for screening and treatment. In this article we describe the rationale for screening and additional laboratory investigations. A prospective, controlled trial is important to define the clinical relevance of the refeeding syndrome and optimize its treatment.
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Ned Tijdschr Geneeskd · Jan 2015
[Psychotropic drug prescription to people with intellectual disability in GP practices].
Antipsychotic drugs are more often prescribed in primary care to people with intellectual disability (ID) with challenging behaviour, sometimes even without a diagnosis, than to those with a diagnosed mental illness. This is shown in a large cohort study in the United Kingdom in primary care and in a Dutch study in three residential care facilities. This prescription behaviour is undesirable. ⋯ The Dutch study showed that antipsychotic drug reduction in people with ID with challenging behaviour led to improved behaviour and improvement of physical parameters. A skilled multidisciplinary team of professionals can help with alternative management strategies for challenging behaviour. These teams should be made available for primary care services.
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Ned Tijdschr Geneeskd · Jan 2015
[3D bioprinting of cartilage: challenges concerning the reconstruction of a burned ear].
Reconstruction of a severely maimed ear is a major challenge. The ear is highly flexible yet tough, and has a very complex three-dimensional shape. Reconstruction of a patient's burned ear is even more complex due to surrounding tissue damage. ⋯ However, 3D bioprinting is a tool to facilitate the reconstruction, and not by itself the Holy Grail. The clinical application of this technique is still at a very early stage. Nevertheless, we expect that 3D bioprinting can be utilised for facial reconstruction following burns come 2020.