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maandag 6 februari 2017

The Lancet: [Comment] High-flow oxygen therapy in acute bronchiolitis

[Comment] High-flow oxygen therapy in acute bronchiolitis
High-flow nasal cannula oxygen (HFNCO) is a relatively novel medical device rapidly becoming the standard of care in hospital management of acute viral bronchiolitis. HFNCO has perceived benefits—so far undemonstrated1—for patient comfort, lung mechanics, and gas exchange,2 but higher associated unit costs than does standard oxygen therapy. An undefined clinical role for HFNCO in bronchiolitis has resulted in variable clinical management—mirroring that seen following the ubiquitous introduction of oxygen-saturation monitoring in the 1980s, which is only now being unraveled.
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[Articles] High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial
HFWHO did not significantly reduce time on oxygen compared with standard therapy, suggesting that early use of HFWHO does not modify the underlying disease process in moderately severe bronchiolitis. HFWHO might have a role as a rescue therapy to reduce the proportion of children requiring high-cost intensive care.
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[Articles] Intra-articular corticosteroids versus intra-articular corticosteroids plus methotrexate in oligoarticular juvenile idiopathic arthritis: a multicentre, prospective, randomised, open-label trial
Concomitant administration of methotrexate did not augment the effectiveness of intra-articular corticosteroid therapy. Future studies are needed to define the optimal therapeutic strategies for oligoarticular juvenile idiopathic arthritis.
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[Comment] The value of old drugs for juvenile idiopathic arthritis
Intra-articular corticosteroids and methotrexate have been used for juvenile idiopathic arthritis throughout the world since the late eighties. These drugs are cheap and effective but there is little firm evidence to substantiate their effect. According to the American College of Rheumatology's recommendations for juvenile oligoarthritis, therapy is usually initiated with intra-articular corticosteroid injections,1 usually triamcinolone.2,3 After progression of the number of joints involved or relapses, methotrexate is started as the second drug.
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[Comment] Schizophrenia, primary negative symptoms, and soft outcomes in psychiatry
Eugen Bleuler, one of the founding fathers of psychiatry, who coined the term schizophrenia in 1908, considered so-called negative symptoms, such as lack of drive and motivation or social withdrawal, to be at the core of the disorder, while he regarded the more dramatic positive symptoms, such as delusions and hallucinations, as accessory.1 Unfortunately, antipsychotics have been shown effective for positive symptoms, but they have limited efficacy for negative symptoms, which remain an unresolved problem.
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