Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
Comparative Study[Reliability of the registration of data on complex patients: effects on the hospital standardised mortality ratio (HSMR) in the Netherlands].
To evaluate the reliability of data registration in calculating the hospital standardised mortality ratio (HSMR). ⋯ Comorbidities in patients with pancreatic carcinoma who undergo a resection are being inadequately recorded in the LMR. This results in insufficient correction in the case mix and a low score on the Charlson index, which could result in an incorrect HSMR.
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Ned Tijdschr Geneeskd · Jan 2012
[Determining burn depth: clinical assessment and laser Doppler imaging].
Early accurate determination of burn depth is important to determine the optimal treatment of burns. The method most used to determine burn depth is clinical assessment. ⋯ It is hypothesised that the introduction of LDI will lead to quicker decisions as to whether or not to operate, possibly leading to a shorter length of hospital stay and lower medical costs. To test this hypothesis, a multicentre randomized controlled trial is presently being conducted in the Dutch burn centres.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[Pregnancy-associated breast cancer: current opinions on diagnosis and treatment].
Because of the trend to postpone childbirth until later in life we will be increasingly confronted with pregnancy-associated breast cancer. We report on two patients with pregnancy-associated breast cancer. ⋯ Pregnancy does not seem to influence the prognosis of breast cancer. All patients with pregnancy-associated breast cancer should be registered in a registration study.
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Ned Tijdschr Geneeskd · Jan 2012
[The 'paper-based' preoperative evaluation: sometimes, a suitable alternative].
In the Netherlands, the majority of elective-surgery patients are evaluated by the anaesthesiologist at the preoperative assessment clinic. We believe that this visit can be omitted in selected patients as it has only minimal benefit, whereas its disadvantages can be substantial. Alternatively, the initial screening could be performed by the completion of a questionnaire via the telephone, via internet, by a nurse or by the surgeon. ⋯ This method does require the conscientious cooperation between anaesthesiologists and surgeons; it should be clear which patients are eligible, what type of anaesthetic technique should be used, how the patient should be informed and how the informed consent is obtained. In our opinion, this paper-based evaluation combines safety and efficiency with patient-friendliness. It should be anchored in current guidelines to ensure quality.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[Decompression illness: minor symptoms, major consequences].
Nowadays, diving is being performed ever more frequently; it is thus important to take diving injuries into consideration in patients presenting with even minor complaints after diving. Every dive is risky and could result in decompression illness, barotrauma and/or death. We report on two cases of decompression illness: a 30-year old man, an occupational diver, and a 46-year old man, an experienced diver, who were both clinically suspected of having decompression illness and were treated with hyperbaric oxygen in a recompression chamber. ⋯ Symptoms vary and are dependent on the site affected: from minor pain to neurological symptoms and death. If patients are suspected of having diving injuries, we recommend contacting a centre specialised in diving and hyperbaric medicine. Recompression in a hyperbaric chamber is the definitive treatment for decompression illness and should be performed as soon as possible.