Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2013
Review[Terminal care in patients with amyotrophic lateral sclerosis].
Patients with amyotrophic lateral sclerosis (ALS) often fear of dying from suffocation. This fear is also common in relatives and caregivers. Research has, however, shown that ALS patients seldom die from suffocation. ⋯ Intensive guidance of the relevant medical, practical and ethical aspects are necessary. Particularly in the pre-terminal and terminal phases, support given to an ALS patient requires a pro-active attitude on the part of the treating physician. To this end, physicians may seek advice from the Dutch ALS Center, a palliative care consultation team, a hospice physician or a center for home mechanical ventilation.
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Ned Tijdschr Geneeskd · Jan 2013
Review[Juvenile idiopathic arthritis: from biomarker to treatment].
Juvenile idiopathic arthritis (JIA) is the most common cause of chronic joint inflammation in childhood. The aetiology is unknown and the pathogenesis is multifactorial. JIA manifests itself in many various ways. ⋯ MRI examination is playing an increasingly important role in making a correct early diagnosis and in assessing response to therapy. After 6 months JIA patients are classified, based on clinical characteristics and laboratory results, into one of the JIA categories according to the criteria of the International League of Associations for Rheumatology. Recent developments in therapy, such as starting biological treatment at an early stage, have led to an improvement in the prognosis of JIA and to structural joint damage occurring less often.
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Despite well-known differences in drug response between children and adults, dosing guidelines for children are usually developed by extrapolating the results from studies in adults. Instead of body weight, insight into the pharmacokinetics and pharmacodynamics of drugs should serve as the basis for dosing in children. ⋯ With a population approach, the covariates that affect the pharmacokinetics and pharmacodynamics of drugs can be identified in a covariate analysis; examples of covariates include body weight, age, degree of illness and genetic factors. Drugs that serve as a model for a specific elimination route provide the basis for individualized dosing guidelines for children.
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Ned Tijdschr Geneeskd · Jan 2013
Review[Guideline 'Wound Care': recommendations for 5 challenging areas].
The interdisciplinary evidence-based guideline 'Wound Care' covers the treatment and management of acute wounds in adults and children and by all wound care disciplines. This guideline answers 5 basic questions with 38 recommendations covering wound cleansing, pain relief, instructing the patient, various dressings and the organisational aspects of wound care. The guideline recommendations include not to cleanse wounds that are primarily closed, to cleanse acute open wounds with clean tap water, to use the WHO pain ladder as the basis for the choice of analgesics for continuous wound pain, to administer lidocaine or prilocaine for localized pain relief during manipulation, not to cover primarily closed wounds with dressings, to use simple dressings for open wounds and to give the patient clear instructions. The guideline also advises about wound registration, documentation and hand-over of wound care, and recommends making clear agreements about referrals and responsibilities.
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Ned Tijdschr Geneeskd · Jan 2013
Review[Treatment of cartilaginous defects in the knee: recommendations from the Dutch Orthopaedic Association].
Cartilaginous defects in the knee occur frequently and can cause the patient considerable limitations. They are diagnosed and classified by means of MRI and arthroscopy. The surgical options available to treat deep chondral lesions include bone marrow stimulation techniques (microfracture treatment), chondrocyte therapies (autologous chondrocyte implantation) and tissue replacement therapies (osteochondral autologous transplantation). ⋯ Autologous chondrocyte implantation is a suitable method for treating single symptomatic chondral lesions larger than 2 cm2 in adults up to 50 years of age. There are no significant differences regarding the effectiveness of microfracture treatment, autologous chondrocyte implantation and osteochondral autologous transplantation for small defects: all show good clinical and functional short- and medium-term results. New second- and third-generation autologous chondrocyte implantation techniques seem to yield more sustainable tissue repair and better clinical long-term results for lesions larger than 4 cm2 in comparison to microfracture treatment.