Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2017
[Pulmonary embolism response teams: what is the added value for patients with acute pulmonary embolism?]
Adequate triaging of patients presenting with acute pulmonary embolism (PE) is essential for appropriate treatment, especially for patients with severe PE. Optimal treatment for this latter group of patients includes pharmaco-mechanical reperfusion treatment for the minority of patients who present with haemodynamic instability, and standard anticoagulation and close monitoring on the ward for the intermediate-high risk patient. ⋯ We discuss the potential role of PERT teams in Dutch hospitals. The main advantage of PERT could be a uniform management strategy that is supported by a multidisciplinary team including all key specialists in the treatment of severe PE.
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Ned Tijdschr Geneeskd · Jan 2017
[E-bikers are more often seriously injured in bicycle accidents: results from the Groningen bicycle accident database].
Analysing injury types, injury severity and mortality in victims of accidents with electric bicycles in comparison with conventional bicycles. ⋯ E-bikers who had a bicycle accident had more severe injuries, more frequently had multiple injuries and had more severe head injuries than conventional cyclists. This resulted in a greater need for care. Preventive measures such as riding lessons and helmet use should be encouraged. Care providers should pay extra attention to the possibility of severe injuries when a patient had a bicycle accident with an e-bike.
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Carotid sinus massage for diagnosis and termination of supraventricular tachycardia (SVT) is still a widely used vagal manoeuvre in the A&E department. However, itsefficacy is limited (termination of the SVT in approximately 20%) and carotid sinus massage may be complicated by (potentially devastating) neurologic complications in 0.2-1% of the patients. ⋯ Carotid sinus massage remains an important diagnostic method in patients with unexplained syncope in whom, based on the clinical history, carotid sinus hypersensitivity is suspected. It should be avoided in patients with previous TIA or stroke within the past 3 months, or those with carotid bruits, except if carotid Doppler studies have excluded significant stenosis (≥ 70%).
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Ned Tijdschr Geneeskd · Jan 2017
[Is dementia preventable through intensive vascular care? The preDIVA trial].
To assess whether intensive vascular care in GP practices can prevent dementia in a population of community-dwelling older people. ⋯ Long-term intensive vascular care for community-dwelling elderly patients, provided in a primary care setting, does not result in a reduced incidence of dementia, functional limitations or mortality. There is, however, possibly an effect in elderly patients with untreated or sub-optimally treated hypertension; this warrants further research.
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Ned Tijdschr Geneeskd · Jan 2017
[Deciding on surgery for acute subdural haematoma; does a neurosurgeon rather fill nursing homes or cemeteries?]
Acute subdural haematoma is a life-threatening condition that can sometimes be mitigated by decompressive craniotomy. However, it can also increase misery when patients survive but are left with severe disabilities. A recent publication shows that neurosurgeons in Belgium and the Netherlands vary considerably in their opinion regarding if, and when, to perform this surgery. ⋯ This requires a value judgement that has to be informed by the flawed and incomplete medical literature and by the perhaps even more flawed and incomplete (relayed) accounts of the wishes and attitudes of the unconscious patient. However, in the end, the surgeon also evaluates his own convictions in the whole issue and this will inevitably introduce subjectivity and practice variation. A structured moral debate may help to improve the extremely difficult decision-making process around the management of acute subdural haematoma.