The Netherlands journal of medicine
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Haemodynamic monitoring may potentially lead to improved quality of care in haemodynamic compromised patients. However, the usefulness of invasive techniques using the pulmonary artery catheter is questioned. Noninvasive techniques which provide data on haemodynamics might provide a good alternative. ⋯ Currently, the device can be used in patients to continuously monitor haemodynamic data and guide therapy. Furthermore, it might have a role in clinical research to noninvasively assess cardiac output, as a surrogate endpoint, before and after interventions. Although this new method seems promising, the clinical value has to be proven.
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In 2007 a national guideline on perioperative nutrition was issued in the Netherlands. As external indicator for adequacy of nutritional therapy, the percentage of malnourished patients who reach at least 1.2 grams of protein on day 4 after admission was chosen by the Netherlands Health Care Inspectorate. ⋯ Our study shows that integration of nutritional advice and automatically generated feedback to users in a data management system consistently improves delivery of (early) nutrition.
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Two decades ago, transfusion-related acute lung injury (TRALI) was considered a rare complication of transfusion medicine. Nowadays, TRALI has emerged as the leading cause of transfusion-related mortality, presumably as a consequence of reaching international agreement on defining TRALI with subsequent increased recognition and reporting of TRALI cases. Specific patient populations such as critically ill patients have an increased risk of developing TRALI, which may be explained by the two-event hypothesis. ⋯ Additional research is needed to determine whether the use of fresh blood products may be an additional measure to reduce TRALI. Studies are also needed to identify at-risk patients. In these studies, we advocate the use of the consensus definition to improve comparability of risk factors and outcome of TRALI across patient populations.
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A 35-year-old man presented at the outpatient department of pulmonary diseases with fever, rhinitis and coughing. He had recently been on holiday in California. Except for a body temperature of 39.7 degrees C there were no other abnormal findings at the physical examination. ⋯ Coccidioidomycosis was the suspected diagnosis and confirmed by the results of CT scanning and culture of bronchoalveolar lavage fluid. Treatment with itraconazole resulted in lasting improvement. The case stipulates the importance of travel history.