Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2017
Review[Injuries resulting from accidents and violence in the Netherlands; results of an Emergency Department register].
- Injuries from accidents and violence are amongst the most important public health issues in the world, including in Europe and the Netherlands.- Using the Dutch Injury Surveillance System and the Dutch Burden of Injury Model, we describe the incidence and costs associated with injuries in the Netherlands that are registered via Emergency Departments (ED). We also map the main causes of injury by age category.- Annually, 700,000 patients attend the ED of a hospital with an injury; 1 in 6 attendees is admitted.- The societal costs of these injuries totals 3.2 billion euro per year. ⋯ Injuries occur relatively more often in children and the elderly.- The key underlying causes differ per age category. Common causes in all ages are cycling accidents, falls from heights, and other fall-related incidents.- The government should continue to deliver the public health interventions for prevention of fall injuries and cycling accidents.
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Ned Tijdschr Geneeskd · Jan 2017
Review[Are nail polish, artificial nails and piercings allowed outside the surgical area?Recommendations for the perioperative policy].
- An increasing number of patients wear nail polish, artificial nails or have piercings.- There is uncertainty about the perioperative management of these items, especially when located outside the surgical area.- In the majority of hospitals, patients are urged to remove these items preoperatively, under the assumption that they might cause problems.- Frequently, however, these items cannot be removed straightforwardly.- Nail polish and artificial nails only very rarely cause perioperative problems and therefore do not need to be removed pre-operatively.- The same applies to most piercings, except when located in or near the respiratory tract, if they have sharp endings or if they might cause problems as a result of the perioperative positioning of the patient.- Providing adequate information to the patient, knowledge about removal of these items and documentation of agreed arrangements are all important.- A national guideline concerning perioperative policy is urgently required.
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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.
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Ned Tijdschr Geneeskd · Jan 2017
[The alpha-gal syndrome: an allergic reaction to mammalian meat secondary to a tick bite].
Here we present the case of a 68-year-old patient with alpha-gal syndrome. This is a delayed-onset allergic reaction, characteristically occurring 2-6 hours after ingestion of mammalian meat products. ⋯ The alpha-gal syndrome is usually self-limiting as long as there are no new tick bites. Clinicians should be aware of this syndrome, which is often not recognized as such.