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Leeuwarden, Netherlands

Wieldraaijer F.,Medisch Centrum Leeuwarden
Nederlands tijdschrift voor geneeskunde | Year: 2011

To determine whether there are any differences between children known to be maltreated and a control group, the goal being an earlier detection of maltreated children in the emergency department (ED). Retrospective case control study. Children in whom child abuse had been ascertained by the Dutch child protection services (Advies- en Meldpunt Kindermishandeling, AMK) in Friesland in 2008, were compared with matched control children from Leeuwarden Medical Centre. For each child we established the total number of ED visits and the number of hospitals visited in Friesland in the 3 years prior to registration at the AMK. For each ED visit we recorded the reason for the visit, type of injury, if applicable, length of delay before seeking medical attention, diagnosis, reason for admission, completeness of the screening questionnaire and registration, if applicable, at the AMK. For each ED visit we assessed in retrospect whether there was a possibility of child abuse, whereby assessors were not aware of the group each child was in. In the group of maltreated children, 93 of the 676 children collectively visited the ED 129 times, compared with 61 of 676 children in the control group who visited 69 times (odds ratio (OR):1.61; 95% CI: 1.14-2.27). 24 (26%) of the maltreated children who visited the ED went more than once; in the control group 6 children visited the ED more than once (9.8%) (OR: 3.19; 95% CI: 1.22-8.35). In retrospect the researchers suspected 11 cases of child abuse in the group of maltreated children but not one in the control group. These results were all significantly different between both groups, the other variables showed no significant difference. For 3 of the 93 maltreated children (3%) contact had been made with the AMK at the time of the most recent ED visit. Children who were maltreated visited the ED more frequently and were more likely to visit the ED several times over a period of 3 years. Child abuse was not sufficiently detected in the ED. Source

This manuscript looks back on the NEOSAFE study, a prospective multicenter survey, which analysed a number of aspects of safety culture, incident reporting and incident analysis. A voluntary, non-punitive incident reporting system (NEOSAFE) was introduced in eight level III Neonatal Intensive Care Units (NICUs) in The Netherlands. An incident was defined as any unintended event which (could have) reduced the safety margin for the patient. After introduction of the voluntary, non-punitive reporting system, the impact of process deviations in the NICU became more visible through the great number of incident reports and subsequent analysis. Future studies should focus on the development of powerful interventions to prevent adverse events in the NICU. © 2014, Bohn, Stafleu van Loghum. Source

Robinson A.P.,Medisch Centrum Leeuwarden
American journal of orthopedics (Belle Mead, N.J.) | Year: 2014

Pseudoaneurysms of the brachial artery are rare and most often occur after a penetrating injury. The incidence of periprosthetic humerus fractures is low, and surgical treatment can be demanding. The treatment of choice for an occluded pseudoaneurysm of the brachial artery is saphenous vein bypass. In this article, we report the case of a 73-year-old woman who presented with an occluded pseudoaneurysm of the brachial artery sustained after a neglected periprosthetic humerus fracture. A saphenous vein bypass was performed after removal of the distal tip of the prosthesis. Patency was observed 3 months after surgery. This case shows malunion of a neglected periprosthetic humerus fracture and a good result after saphenous vein bypass. Source

To determine the prevalence of gestational diabetes mellitus in high-risk pregnancies during the second or third trimester diagnosed by screening with the 75-gram oral glucose tolerance test (75 g-OGTT) and, to determine the prevalence of the need for insulin therapy after an initial dietary intervention. Prospective cohort study. Pregnant women at high-risk for gestational diabetes mellitus were challenged with the 75 g-OGTT in the second or third trimester, ideally between the 24th and the 28th week of pregnancy. The diagnosis of gestational diabetes mellitus was established when the fasting plasma glucose was ≥ 7.0 mmol/l or when the plasma glucose was ≥ 7.8 mmol/l two hours after the oral ingestion of 75 g glucose. The women with gestational diabetes were initially treated with a dietary regime. Insulin treatment was added if the hyperglycaemia persisted. A total of 471 pregnant women were included. Of these women, 75.8% underwent the 75 g-OGTT between the 24th and 28th week of pregnancy; 24.2% underwent the test between the 28th and 35th week. The diagnosis of gestational diabetes mellitus was established in 24.2% of the pregnant women. Dietary intervention was successful in normalising the blood glucose levels in 77.2% of the cases. The remaining 22.8% needed the additional insulin treatment. We ascertained that the prevalence of gestational diabetes mellitus in high-risk pregnancies was high. In most cases, the gestational diabetes mellitus could be managed by diet. A multidisciplinary approach involving obstetricians, gynaecologists, dieticians and internists is needed to ensure a timely diagnosis and adequate treatment during pregnancy. Source

de Visscher J.G.,Medisch Centrum Leeuwarden
Nederlands tijdschrift voor tandheelkunde | Year: 2013

A 47-year-old man was referred to an oral and maxillofacial surgeon by his dentist because ofa painful ulcer with exposed bone at the lingual side of teeth 47 and 48. The lesion was diagnosed as lingual mandibular osteonecrosis. Characteristics of lingual mandibular osteonecrosis are exposed bone in the molar area and sequestration. The disorder can appear spontaneously or following damage to the mucous membrane. Treatment options are surgical smoothening of exposed bone, surgical removal of necrotic bone and awaiting spontaneous sequestration. Source

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