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Inleiding Maagballonnen worden toegepast als alternatief voor bariatrische chirurgie of voorafgaand aan bariatrische chirurgie om de complicaties van de ingreep te verminderen. Dit artikel bekijkt het bewijs voor de werkzaamheid bij beide toepassingen. Methoden In de literatuur is gezocht naar gerandomiseerd onderzoek of meta-analyses naar de effectiviteit en de complicaties van een primaire behandeling van obesitas met een maagballon en voor de toepassing voorafgaand aan bariatrische chirurgie. Resultaten Onderzoeken laten zien dat na plaatsing van een maagballon (intragastrische ballon - IGB) gewichtsverlies optreedt, maar gegevens over gewichtsverlies op langere termijn ontbreken. Uit onderzoek blijkt ook dat bij bariatrische chirurgie plaatsing van een maagballon in de maanden voorafgaand aan de ingreep wel helpt om het lichaamsgewicht te verminderen, maar niet om complicaties na de operatie te voorkomen. Discussie Uit het schaarse gerandomiseerde onderzoek blijkt de gewichtsafname door plaatsing van een maagballon klinisch relevant, maar het gewicht neemt weer toe als de maagballon wordt verwijderd. De toepassing van maagballonnen bij gewichtsvermindering al dan niet voorafgaand aan bariatrische chirurgie wordt terecht niet vermeld in de Nederlandse richtlijnen, omdat er onvoldoende onderzoek is gedaan om de balans tussen de effectiviteit en de bijwerkingen in te kunnen schatten. [ABSTRACT FROM AUTHOR]

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This paper explains the strategic importance of internal communications, and offers a simple model for managing the process of effective internal communications. Discussion includes defining internal communications, strategic importance of internal communications, integrating internal communications strategy as a natural part of everyday working life, and an example of strategic internal communications in practice at the University of Durham.

Copyright of Geneesmiddelenbulletin is the property of Stichting Geneesmiddelenbulletin and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Geneesmiddelenbulletin is the property of Stichting Geneesmiddelenbulletin and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses the strategic importance and the process of effective internal communications. Potentially huge strategic value of internal communications; Plan of a commensurate strategic impact; Model of delivery of critical success factors.

In breast cancer patients discontinuing chronic tamoxifen therapy, the serum elimination of metabolites X, Y and E paralleled that of tamoxifen, whereas that of metabolite Z did not. The serum elimination of tamoxifen and metabolites X and B was increased by amino-glutethimide treatment, whereas that of metabolites Z, Y, and E was not. [ABSTRACT FROM AUTHOR]

Objectives: To compare the effectiveness of an early switch to oral antibiotics with the standard 7 day course of intravenous antibiotics in severe community acquired pneumonia., Design: Multicentre randomised controlled trial., Setting: Five teaching hospitals and 2 university medical centres in the Netherlands., Participants: 302 patients in non-intensive care wards with severe community acquired pneumonia. 265 patients fulfilled the study requirements., Intervention: Three days of treatment with intravenous antibiotics followed, when clinically stable, by oral antibiotics or by 7 days of intravenous antibiotics., Main Outcome Measures: Clinical cure and length of hospital stay., Results: 302 patients were randomised (mean age 69.5 (standard deviation 14.0), mean pneumonia severity score 112.7 (26.0)). 37 patients were excluded from analysis because of early dropout before day 3, leaving 265 patients for intention to treat analysis. Mortality at day 28 was 4% in the intervention group and 6% in the control group (mean difference 2%, 95% confidence interval -3% to 8%). Clinical cure was 83% in the intervention group and 85% in the control group (2%, -7% to 10%). Duration of intravenous treatment and length of hospital stay were reduced in the intervention group, with mean differences of 3.4 days (3.6 (1.5) v 7.0 (2.0) days; 2.8 to 3.9) and 1.9 days (9.6 (5.0) v 11.5 (4.9) days; 0.6 to 3.2), respectively., Conclusions: Early switch from intravenous to oral antibiotics in patients with severe community acquired pneumonia is safe and decreases length of hospital stay by 2 days., Trial Registration: Clinical Trials NCT00273676 [ClinicalTrials.gov].