The Netherlands journal of medicine
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The lung is at the crossroads of ventilation and circulation and can provide a wealth of diagnostic information. In the past, lung ultrasound (LUS) was considered impossible. However, the interplay between air, fluid and pleurae creates distinctive artefacts. Combinations of these artefacts can help differentiate between various pathological processes, including pulmonary oedema, pneumonia, pulmonary embolism, obstructive airway disease and pneumothorax. LUS, when used by experienced physicians, is superior to chest X-ray and comparable to computed tomography for establishing a diagnosis in acutely dyspnoeic patients. LUS allows for rapid, non-invasive and bedside patient assessment. It is therefore unfortunate that unlike many other medical specialists in the Netherlands, internists have not yet incorporated LUS into their daily practice. ⋯ LUS is a promising diagnostic technique that can be of great help for the internist. It can be applied directly at the bedside and can also be used to follow up on disease progression and therapy. It is our belief that it will replace the stethoscope and that it will be the most used imaging technique in the near future, especially in dyspnoeic patients.
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Multicenter Study
The standardised mortality ratio: the proper quality indicator in acute leukaemia?
The standardised mortality ratio (SMR) is a quality indicator used to measure quality of care in the Netherlands. It is subject to much criticism, which was the reason to study the value of the SMR as a quality indicator for the treatment of acute leukaemia. ⋯ Outcome according to SMR is not equivalent to outcome according to OS. This study shows that the use of the SMR as a quality indicator for the treatment of acute leukaemia does not appear to be justified.
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To examine the increase in serum 25(OH) vitamin D levels after supplementation with 800 IU/day of vitamin D in patients with low vitamin D levels and which factors affected the increase in vitamin D levels. ⋯ We found that the generally recommended dosage of 800 IU of vitamin D per day resulted in suboptimal serum levels after ten weeks of treatment in more than half of the patients. The increase in vitamin D levels was higher in patients with low body weight and in patients with very low basal vitamin D levels. These data suggest that these patients should initially be treated with higher dosages of vitamin D. If not possible, vitamin D measurements should be performed after at least six months of supplementation with dosage adjustment.