Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jun 2004
Review[Coping with grief following perinatal death: a multifaceted and natural process].
Coping with grief following perinatal death is a natural process that every individual experiences in his own personal and unique way. Parents go through varying emotions in the months following the death of their baby. ⋯ Parents benefit from individually focused counseling and assistance in making their own choices with regard to saying goodbye and the way in which they will cope with their grief in the immediate future, as parents, within the family and in relation to the people in their surroundings. It is recommended that the attention for the parents and their lifeless child and all care behaviour be the same, as much as possible, as after the birth of a living child.
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Ned Tijdschr Geneeskd · Jun 2004
Review[Valganciclovir. Oral treatment of Cytomegalovirus infections].
Valganciclovir is an orally administered prodrug of ganciclovir, the most widely used drug in the clinical management of Cytomegalovirus infections. The good bioavailability and the rapid conversion into ganciclovir provide oral valganciclovir with pharmacokinetic properties approaching those of intravenously administered ganciclovir. ⋯ Broader application of valganciclovir is to be expected in the pre-emptive treatment of organ as well as stem-cell transplant recipients. This drug also increases the potential for prophylactic applications, which may lead to the development of viral resistance.
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Ned Tijdschr Geneeskd · May 2004
Review[Nutrition and health--enteral nutrition in intensive care patients].
Nutritional therapy in the intensive care unit exerts favourable effects on morbidity and mortality. Enteral nutrition is preferable to parenteral nutrition. Only perforation or total obstruction of the gastrointestinal tract, proven mesenteric ischaemia and toxic megacolon are absolute contra-indications to enteral nutrition. ⋯ The use of immunonutrition, notably in surgical intensive care patients, has a favourable effect on the incidence of infectious complications, the duration of artificial respiration and the length of hospital stay. The addition of glutamine to parenteral nutrition may reduce mortality compared to standard parenteral nutrition. Implementation of a simple feeding algorithm in the intensive care unit, with special attention for the treatment of delayed gastric emptying, is cost-effective and leads to an improvement in the nutritional parameters.
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The concept of autism has been broadened the last few years from 'early infantile autism' to 'an autistic spectrum'. Autism and related contact disorders are grouped together under 'pervasive developmental disorders' or 'autistic spectrum disorders'. The autistic disorder, Asperger's syndrome, pervasive developmental disorder not otherwise specified (PDD-NOS), Rett's disorder and the childhood disintegrative disorder all belong to this group. ⋯ In the intervention, a distinction is made between family-oriented and child-oriented strategies. Augmentative communication plays a key role in the treatment. People with autism need a lot of structure, clarity and predictability, also when they have become adults.
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Ned Tijdschr Geneeskd · May 2004
Review[Sepsis, a complicated syndrome with major medical and social consequences].
Severe sepsis is a life-threatening complication of infection. Due to associated organ-failure treatment in an Intensive Care Unit is usually indicated. Since sepsis is defined by the combination and progression of clinical events, correct definitions are essential to enable good comparison between study results and determination of suitable treatment. ⋯ Direct medical costs of severe sepsis are estimated at [symbol: see text] 19,500 per patient. Costs correlate strongly with the length of stay. Annually Euro dollar 168,6 million is spent on severe sepsis, which represents 0.5% of all health-care costs and 1.7% of the annual hospital budget in the Netherlands.