The Netherlands journal of medicine
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Letter Multicenter Study
BeCaf study: caffeine and behaviour in nursing homes, a study protocol and EBM training program.
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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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Randomized Controlled Trial Multicenter Study
Antibiotic treatment of moderate-severe community-acquired pneumonia: design and rationale of a multicentre cluster-randomised cross-over trial.
For the empirical treatment of community-acquired pneumonia requiring admission to a non-ICU ward, the Dutch guidelines recommend either beta-lactam monotherapy, beta-lactam and macrolide combination therapy, or fluoroquinolone monotherapy. The lack of convincing evidence to preferentially recommend any of the three empiric regimens results from intrinsic limitations of current studies, such as bias by indication and residual confounding in observational studies, and the unknown effects of pre-randomisation antibiotic use in randomised controlled trials. In this paper we discuss the methodological drawbacks of observational cohorts and randomised controlled trials in antibiotic therapy. Next, we explain why we designed a multicentre cluster-randomised cross-over study to evaluate the effectiveness of three antibiotic treatment strategies, consisting of a preferred treatment regimen of beta-lactam monotherapy, beta-lactam and macrolide combination therapy or fluoroquinolone monotherapy, in adult patients admitted to a non-ICU ward with a clinical diagnosis of community-acquired pneumonia. Furthermore we outline different aspects of this design that deserve thorough consideration. ⋯ We discuss different aspects of a cluster-randomised cross-over trial that is designed to determine the effects of three recommended regimens of antibiotic treatment of CAP.
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Randomized Controlled Trial Multicenter Study
Maintenance treatment with budesonide 6 mg versus 9 mg once daily in patients with Crohn's disease in remission.
In previous trials, budesonide 6 mg/day was able to prolong the time to relapse in patients with quiescent Crohn's disease and budesonide 9 mg/day was effective in active disease with limited side effects. The aim of this study was to compare the effectiveness of budesonide 9 mg vs 6 mg once daily on the maintenance of remission and occurrence of adverse events. ⋯ The one-year relapse rates were low and not significantly different between the group of patients treated with budesonide 6 mg vs 9 mg/day. Also, time to relapse and the number of adverse events were similar in both treatment groups.