Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2011
[Rapid response system in derangement of vital signs: five years experience in a large general hospital].
Hospitalized patients are at risk for adverse events such as unexpected cardiac arrest or admission to an Intensive Care Unit (ICU). Prior to these adverse events these patients often have derangements in vital signs that are not recognized and treated adequately. To identify and treat those patients at risk, our hospital implemented a rapid response system in 2004. The purpose of this paper is to describe implementation and results of our rapid response system. ⋯ In our hospital the rapid response system has developed into an important tool for the early identification and treatment of patients at risk. However, our data cannot prove the efficacy of the rapid response system in terms of reducing hospital mortality.
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Ned Tijdschr Geneeskd · Jan 2011
Case Reports[When the end is near: an ICU patient who died at home].
We describe the process of transferring a 64-year-old male from a Dutch intensive care unit to his home so that he could die there. He was a respirator-dependent cardiac surgical patient; his intensive care treatment had been withdrawn. ⋯ We discuss the natural cause of death and subsequent administrative steps. Based on the positive reactions of the patient and his family, we propose to incorporate this process into Dutch intensive care practice guidelines.
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Ned Tijdschr Geneeskd · Jan 2011
Practice Guideline[Multidisciplinary guideline 'Heart failure 2010'].
In the multidisciplinary practice guideline 'Heart failure 2010', the diagnosis of heart failure relies on a combination of signs and symptoms and on supplementary investigation with natriuretic peptides and echocardiography. Once diagnosed, it is important to detect the potentially treatable cause of the heart failure. The non-medical treatment consists of lifestyle advice, of which regular body exercise is the most important component. ⋯ A restricted group of patients may require an internal cardiac defibrillator (ICD) and/or cardiac resynchronisation therapy. There is limited scientific evidence concerning treatment of patients with diastolic heart failure. It is important to coordinate the care of the patient with heart failure within a multidisciplinary team to provide optimal treatment and information for the patient.
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A 89-year-old woman came to the hospital with abdominal pain, vomiting and melaena. A CT-scan showed the complaints were caused by a hernia obturatoria incarcerata. After surgery the woman recovered uneventfully.
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A 50-year-old woman developed Mees' lines on her nails after chemotherapy for infiltrating lobulair carcinoma of the breast.