Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Nov 2006
Review[The practice guideline 'Volume suppletion in critically-ill neonates and children up to the age of 18 years' of the Dutch Paediatric Association].
Hypovolaemia is the most common cause of circulatory failure in children. Treatment consists of volume suppletion with a crystalloid or colloid solution; which agent is the best in children is not clear. This evidence-based practice guideline formulates recommendations as to which fluid should be used for volume suppletion in critically-ill neonates and children up to the age of 18 years with hypovolaemia. ⋯ On the basis of data from the literature and considerations regarding the applicability of evidence in adults to children and neonates, the side effects of resuscitation fluids, pathophysiology and costs, the first-choice fluid for neonates and children with hypovolaemia is isotonic saline. Albumin should not be used for the treatment of hypovolaemia. The volume to be administered and the infusion rate depend on the severity of the hypovolaemia and should be determined on an individual basis.
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Ned Tijdschr Geneeskd · Oct 2006
Review[The relationship between atherosclerosis, cognitive impairment, and depression in old age].
It has been suggested in the literature that atherosclerosis is a common causal pathway of cognitive impairment and late-onset depression, which may explain their co-occurrence in old age. In both the 'Leiden 85-plus Study' and the literature, strong evidence is found for a causal relationship between atherosclerosis and cognitive impairment, but there is less evidence for a causal relationship between atherosclerosis and late-onset depression. In the 'Leiden 85-plus Study', cognitive impairment was a risk factor for the development of late-onset depression, but depression in old age did not predict cognitive decline. This means that the prevention of atherosclerosis might prevent cognitive impairment and hence late-onset depression in old age.
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Ned Tijdschr Geneeskd · Sep 2006
Review[End-of-life decisions in seriously ill patients: the position of intensive care nurses].
Intensive care units regularly have patients in whom a curative treatment plan is changed to palliative treatment. This does not only concern the medical and technical aspects, but also medical-ethical problems and questions relating to communication and organization. ⋯ The optimalization of collaboration between doctors and nurses by means of the mutual exchange of information unique to each different discipline as well as acknowledging one another's talents and skills, forms the basis of good communication and organization concerning end-of-life decisions. It is useful to formalize this collaboration by means of multidisciplinary discussions.
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Ned Tijdschr Geneeskd · Jul 2006
Review Meta Analysis[Efficacy and adverse reactions of antipsychotics for neuropsychiatric symptoms in dementia: a systematic review].
To assess the efficacy and adverse reactions of typical and atypical antipsychotics in the treatment of neuropsychiatric symptoms in dementia, and to examine the evidence for the cerebrovascular events warning for atypical antipsychotics. ⋯ The efficacy of typical and atypical antipsychotics is comparable, but only low-dose risperidone seems to be associated with fewer (extrapyramidal) side effects. The adverse reactions are inadequately described in the published data and consequently the warning of an increased risk of mortality could not be confirmed.
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Care for the polytraumatized patient in the pre-hospital phase has improved rapidly in recent years. This has resulted in more patients being alive on arrival at the hospital. The treatment of polytraumatized patients requires a different approach to that of regular trauma patients because they are threatened not only by the injuries themselves but also by the metabolic disruptions that follow. ⋯ The second phase consists of resuscitation on the Intensive Care Unit and the third phase aims at definitive repair of the sustained injuries. Despite the low level of evidence found in the literature, DCS seems to reduce mortality rates in polytraumatized patients. Therefore, when initiated correctly and at the right moment, it appears to be a promising technique.