[Body dysmorphic disorder in cosmetic surgery - prevalence, psychiatric comorbidity and outcome]. / Stoornis in de lichaamsbeleving bij patiënten binnen de cosmetische chirurgie.

BACKGROUND: Patients suffering from body dysmorphic disorder (bdd) are preoccupied with a slight or imagined defect in appearance. AIM: First of all, to review the literature on the prevalence of bdd in cosmetic surgery and thereafter to review the literature on psychiatric comorbidity and the outcome of surgical interventions. METHOD: We based our search strategy on Embase, Medline and PubMed, using the search terms 'body dysmorphic disorder', 'cosmetic surgery', 'prevalence', 'comorbidity' and 'outcome'. Our search covered English and Dutch literature published after the introduction of bdd in dsm-iii-r and before 1 November, 2013. A study of the relevant articles enabled us to access additional articles mentioned in these texts. RESULTS: Our initial search strategy turned out to be too narrow. It was therefore broadened to include 'body dysmorphic disorder', 'cosmetic surgery', and 'prevalence'. Eventually we included 23 original articles. In 11 of these the prevalence of bdd varied from 3.2 to 53.6%. Twelve articles on psychiatric comorbidity revealed predominantly mood and anxiety disorders on axis I and cluster C personality disorders on axis II. Only two studies reported on the outcome of cosmetic surgery performed on bdd patients; surgical interventions, however, seemed to result in new preoccupations with the prolongation of psychiatric comorbidity. CONCLUSION: bdd is a common psychiatric disorder that can sometimes lead to cosmetic surgery. However, pre-operative screening of bdd patients is vital so that efficient psychiatric treatment can be initiated and patients are not subjected to surgical interventions which may be ineffective or even harmful.

[Acute care of critically ill children in general hospitals: organisation and training]. / Acute opvang van kinderen in algemene ziekenhuizen.

OBJECTIVE: To gain insight into how the acute care of critically ill children at general hospitals is organised, whether staff is sufficiently trained and whether the necessary materials and medications are present. DESIGN: Questionnaire combined with a site visit. METHOD: Questionnaires were sent to all primarily involved specialists (emergency room specialists and paediatricians), and to the auxiliary anaesthetists and intensivists involved, at the nine general hospitals in Southeast Netherlands. Two researchers performed standardised interviews with the lead paediatricians on site and checked for materials and medication present in the emergency and paediatric departments. RESULTS: Of the 195 questionnaires sent, 97 (49.7%) were deemed suitable for analysis. The response from the primary specialists involved (77.6%) was more than twice that of the auxiliary specialists (31.9%). At 7 hospitals, verbal agreements on the organisation of acute care were maintained, 1 hospital had a written protocol, and 2 hospitals had a task force addressing this topic. One out of 5 respondents was unaware of the verbal agreements and 1 out of 3 mistakenly assumed that a protocol existed. Two out of 3 primary specialists involved were certified for Advanced Paediatric Life Support (APLS); 1 out of 13 of the auxiliary specialists had such a certificate. Scenario training was being conducted at 8 hospitals. A paediatric resuscitation cart was available at both the emergency and paediatric departments of 8 hospitals, 3 of which were fully stocked at both departments. Laryngeal mask airways and PEEP-valves (Positive End Expiratory Pressure) were lacking at 6 of the 9 hospitals. The medication stock was complete at all the hospitals. CONCLUSION: The organisation of and training for the acute care of critically ill children and presence of materials - the aspects we investigated - need attention at all general hospitals evaluated. It appeared that many specialists are not APLS certified and written protocols concerning organisation and training were lacking. The establishment of a task force responsible for the acute care of children is one measure that could result in rapid improvement. Another measure could be the introduction of a standardised list of inventory needed for acute care.