Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · Apr 2020
Review Case Reports[Atypical clinical picture of COVID-19 in older patients].
Clinical characteristics and outcomes among older patients with a SARS-CoV-2 infection differ greatly from those seen in younger patients. Here we highlight atypical presentations of this fulminant infectious disease COVID-19, based on a clinical case and a cohort of 19 patients admitted to a geriatric ward. ⋯ As in other countries, morbidity and mortality is most severe among frail male patients; therefore, assessment of changes suggestive of typical acute geriatric syndromes in frail older patients with chronic diseases should lead to a careful clinical examination for a SARS-CoV-2 infection. Protocols for diagnosis, and contact isolation measures, should take these atypical presentations into account.
-
Ned Tijdschr Geneeskd · Oct 2019
Review[Steps for reducing the carbon footprint of the operating room].
The healthcare sector contributes significantly to global warming due to carbon emissions; this sector is, therefore, partially responsible for the negative effects of climate change on public health. Carbon emissions by the healthcare sector amount to 7% of the total carbon footprint of the Netherlands. It is anticipated that measures to reduce carbon emissions in the operating room (OR) can make an important contribution to reducing carbonemissions in the hospital as a whole. ⋯ Direct carbon emissions by the OR can be reduced through the use of sustainable energy and setback of the HVAC outside office hours. Anaesthetists can dramatically reduce the carbon footprint of the OR by choosing for intravenous anaesthetics instead of inhalation anaesthetics. Indirect carbon emissions and waste production by the OR can be reduced through circular procurement, choosing reusable over disposable products and recycling.
-
Ned Tijdschr Geneeskd · Aug 2019
Review Case Reports[Penetrating neck injury caused by stabbing: a rare but complex problem in the Netherlands].
Penetrating neck injuries (PNIs) as a result of stabbing or deliberate self-harm are complex and potentially life-threatening. Nowadays, selective non-operative management of PNI has become common practice. Diagnostic and treatment algorithms originating from high-volume trauma centres in South-Africa and North-America are used in Dutch clinical practice. ⋯ One patient, aged 57, was haemodynamically unstable and therefore received immediate surgical exploration of the neck. A penetrating injury of the jugular vein was discovered and repaired. A summary of literature and guidelines is presented for the benefit of Dutch physicians that may be confronted with these complex injuries.
-
From experiments by the Nazis in Germany, to the infamous American Tuskegee study, controversies surround racialized medical science and clinical practice. However, although 'race' is a social construct, disease patterns may cluster in groups with a common ethno-cultural ancestry. In this journal, Buckle and Achterbergh et al. discuss the use of race and ethnicity in a medical context in the Netherlands. ⋯ A comment on these papers states that the term 'race' is controversial and biologically invalid, and should not be used in medical practice in the Netherlands. A client's self-described ethnic origin or ancestry may be taken into account when relevant for diagnosis and treatment, without equating European ancestry with 'normalcy', as opposed to other ethnic groups. It is concluded that more research should be directed towards defining biomarkers that transcend racialized human categorization based on presumed external characteristics.
-
Ned Tijdschr Geneeskd · Jan 2019
Review[Application of new glucose lowering drugs: DPP-4 inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors].
A comprehensive review of the literature on DPP-4 inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors has resulted in small changes to the medication roadmap of the type 2 diabetes mellitus standard of the Dutch College of General Practitioners. SGLT-2 inhibitors and GLP-1 receptor agonists may have benefits related to cardiovascular outcomes in patients with high cardiovascular risk, especially in those who have experienced a cardiovascular event. However, ascribing effectiveness related to cardiovascular outcomes on the basis of a single cardiovascular safety trial is premature. Metformin, sulfonylurea derivatives and insulin are still the cornerstone of type 2 diabetes mellitus treatment in primary care.