Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
[Guidelines are made more transparent with the GRADE method: considerations for recommendations are explicit in the new method].
GRADE (Grading of Recommendations Assessment, Development and Evaluation) is a new method to represent the quality of evidence and strength of recommendations in guidelines more transparently. In this article, we describe the benefits of GRADE as applied to a recommendation from the guideline "Treatment of asthma in children". A new feature of GRADE is that the relevant outcome criteria are specified in advance and that the quality of evidence is assessed per outcome criterion. ⋯ The strength of the recommendation depends not only on the quality of evidence, but also on considerations such as the balance between benefits and adverse effects, patient preferences and costs. When using GRADE to formulate guidelines, these considerations are made explicit. Using GRADE can lead to different recommendations than older methods and to improved acceptance and implementation in clinical practice.
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Ned Tijdschr Geneeskd · Jan 2012
[Lung cancer staging by endobronchial ultrasound with transbronchial needle aspiration].
To determine the diagnostic yield of endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) and to investigate the number of cervical mediastinoscopies that could be avoided when this technique was used as the initial modality in the invasive mediastinal staging of lung cancer. ⋯ In more than 50% of lung cancer patients with suspected mediastinal lymph node metastases, cervical mediastinoscopy can be avoided when EBUS-TBNA is used. This examination is the technique of first choice for the invasive staging of the mediastinum in lung cancer, but it can not replace mediastinoscopy completely.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[Lucio's phenomenon in a patient with leprosy on Aruba].
Lucio's phenomenon is a rare leprosy reaction characterised by bizarrely-shaped, purpuric skin lesions and ulceration. It occurs in diffuse lepromatous leprosy and it is mainly reported in patients from Mexico and the Caribbean. ⋯ Lucio's phenomenon led to a diagnosis of leprosy. Leprosy is still endemic in Aruba.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[A neonate with peculiarly arranged skin abnormalities].
A tropical doctor reviewed a female Malawian neonate with a vesicular rash and linear hyperpigmentation that followed the lines of Blaschko. This distribution is typical for incontinentia pigmenti, a congenital X-linked dermatosis, which usually resolves spontaneously in adolescence.
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Ned Tijdschr Geneeskd · Jan 2012
[Endoscopic versus surgical treatment of infected necrotising pancreatitis: the TENSION study].
In patients with infected necrotising pancreatitis there is a significant risk (40%) of complications and mortality with the surgical step-up approach. This approach consists of percutaneous retroperitoneal drainage, if necessary followed by video-assisted retroperitoneal débridement. ⋯ The Dutch Pancreatitis Study Group has recently started the nationwide randomized TENSION-trial, in which in 98 patients the endoscopic step-up approach is compared with the surgical method. The primary endpoint is a composite of mortality and major morbidity (new onset organ failure, bleeding, perforation of a hollow organ or incisional hernia for which intervention is needed).