Nederlands tijdschrift voor geneeskunde
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Since its introduction in 1984, selective decontamination of the digestive tract has had clear supporters and opponents. De Smet et al. conducted a large national study in 13 Dutch intensive care units, investigating the effects of the following 3 regimens on mortality: standard treatment, selective decontamination of the digestive tract and selective oropharyngeal decontamination. The results showed decontamination to have a clear benefit in terms of reducing mortality. Based on these results, decontamination should be used in all intensive care patients.
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Energy policy and climate policy are two different issues and should not be treated as if they were the same. Whether the climate gets warmer or colder, saving energy and developing sustainable forms of energy production remain of paramount importance because fossil hydrocarbons are likely to be exhausted soon. But climate policy is a fallacy: it is human arrogance to think we can control the climate by reducing emissions and by storing CO2 underground. ⋯ Since the International Panel on Climate Change (IPCC) did not predict this, it is questionable whether they can reliably predict warming. Other factors such as solar activity are probably more important for climate than greenhouse gases. The danger of coupling energy policy to climate policy is evident: if the climate cools down, people will lose belief in the greenhouse effect and therefore also lose interest in saving energy.
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Ned Tijdschr Geneeskd · Jan 2009
[Medicinal use of cannabis in the Netherlands: towards a responsible pattern of use].
Since 2003, medicinal cannabis has been legally cultivated and distributed in the Netherlands under the auspices of the Dutch Office of Medicinal Cannabis (BMC), part of the Ministry of Health, Welfare and Sport. As a result of this measure, the indication, dosage, administration route, and safety of cannabis can now be investigated, information necessary for justifying its potentially future position as a standard medicinal product. Despite the current lack of reliable scientific efficacy data, standardised medicinal cannabis without microbes has also been made available on prescription. ⋯ Despite disappointing sales at the end of 2007, the Minister of Health, Welfare and Sport has announced that the current policy will be extended for a further five years. The Minister also indicated that he would consider discontinuing the availability of medicinal cannabis for patients, if new cannabis products are granted market authorization. This might, however, give rise to a new era of illegal cannabis use for medicinal purposes, notably for the use as a whole product.
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Since August 7th, treatment with neuraminidase inhibitors (oseltamivir) in the Netherlands has been limited to those patient groups who are considered at high risk of influenza-related complications. This policy is based on one study which shows only limited evidence of the effectiveness of neuraminidase inhibitors in lowering the number of such complications.
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Delirium is a common condition in the intensive care unit (ICU). Between 16-89% of all ICU patients experience an episode of delirium during admission. Several detection tools have been developed for use specifically in the ICU. ⋯ The prognosis for ICU patients who experience delirium is worse than for those who do not. Delirious patients are more likely to develop complications, spend longer in hospital and have a higher mortality rate. In view of the high frequency, poor prognosis, high costs and lack of studies into the treatment of ICU delirium, research into the possibilities for prevention, early detection and treatment of the condition is essential.