Nederlands tijdschrift voor geneeskunde
-
The debate continues whether there is a difference in patient outcome following inhalational versus intravenous anesthesia. A recent meta-analysis showed improved outcome following inhalational anesthesia in patients undergoing cardiac surgery but not in patients undergoing non-cardiac procedures. In this article we discuss the meta-analysis and its caveats, taking into account additional comparative studies. Our overall conclusion is that it is too early to definitively claim that one anesthesia technique results in a better outcome than the other.
-
- Inappropriate use of antibiotics in patients without bacterial infection contributes significantly to worldwide antibiotic resistance.- The goal of this review is to summarise evidence from randomised trials investigating the value of the biomarker procalcitonin (PCT) in patients with symptoms of a bacterial infection in the emergency department (ED) and intensive care (IC).- In patients with a lower respiratory infection in the ED, RCTs demonstrate that withholding or shortening of antibiotic treatment in patients with low PCT levels does not lead to a change in clinical outcome. Similar results were observed in IC patients, where a reduction in PCT level indicates that antibiotics can be discontinued sooner.- In conclusion, initiating and discontinuing antibiotics in ED and IC patients based on PCT levels is safe, appears cost-saving and leads to a reduction in antibiotic use due to fewer antibiotics prescriptions and shortened courses.
-
Multicenter Study
[National developments in Emergency Departments in the Netherlands: numbers and origins of patients in the period from 2012 to 2015].
Gaining insight into key figures of emergency departments (EDs) in the Netherlands and developments in these figures. ⋯ The number of EDs is decreasing and the cooperation between EDs and GPCs has intensified. The number of patients seen in the ED has decreased. The percentage of self-referrals has decreased and the number of hospital admissions from the ED has increased significantly. For a successful and consistent policy, more substantive data on the nature and extent of emergency care in the ED are needed. This requires a national registry.
-
- Overfeeding of critically ill patients is associated with a higher incidence of infections and an increased length of ventilation. However, trophic nutrition or permissive underfeeding appears to have no negative effect on the patient and may even provide a survival benefit.- Initiation of enteral nutrition within 24-48 hours after Intensive Care Unit (ICU) admission may reduce the number of complications and increase the chance of survival.- Total parenteral nutrition is associated with a higher risk of infections than enteral nutrition. This seems to be related to the higher calorie intake with parenteral nutrition rather than the route of administration.- In previously well-nourished patients, in whom enteral nutrition is only partially successful, it is safe to wait for up to 8 days before initiating supplemental parenteral nutrition.- In critically ill children, it is also safe to start supplemental parenteral nutrition at a late (on the 8th day after admission) rather than an early stage (within 24 hours of admission). Late supplemental parenteral nutrition may even result in fewer infectious complications and shorter hospitalisation.
-
The Dutch National Care for the Elderly Programme (NPO) was launched as a large-scale project, in which screening for vulnerability, followed by a comprehensive geriatric assessment, played an important role. An oft-cited explanation for the poor effects of the NPO projects is the high quality of Dutch primary care. However, the complexity of frail elderly care raises the question as to whether the competence of a nurse or practice nurse is sufficient to ensure proper care and treatment. ⋯ Medical care for the frail elderly needs instead to be patient-centred and encompass jointly established goals. This approach offers opportunities to reduce unwanted hospitalisations and referrals to secondary care. This view underlies the University Practice Elderly Care Medicine, where general practitioners and specialists in elderly care medicine collaborate in the care and treatment of vulnerable elderly patients, and satisfaction, continuity of care and concerns of compliance with life goals are the outcome measures.