Nederlands tijdschrift voor geneeskunde
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Not all questions concerning therapeutic effects in medical research can be answered satisfactorily by standard trials. The stepped wedge cluster design is a special form of randomised study in which an intervention at group level is implemented in stages. ⋯ The statistical analysis of cluster trials should account for the fact that individuals within clusters may show many similarities. Ethical aspects of stepped wedge design should be considered carefully, especially when obtaining individual informed consent is not possible.
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Blunt scrotal trauma, mostly induced by sports injuries, can cause a testis rupture. Patient exhibit extreme pain and swollen tender testicle. ⋯ A rupture or a suspicion thereof requires a surgical exploration. Delay of diagnosis can cause irreversible damage to the testicle.
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Ned Tijdschr Geneeskd · Jan 2012
Review[Eosinophilic oesophagitis: a frequently missed cause of dysphagia].
Oesophageal dysphagia is the subjective feeling that there is a problem with the passage of solids or liquids through the oesophagus. The differential diagnosis of dysphagia is long and can be divided into mechanical and motility disorders. Dysphagia is an alarming symptom which requires short-term endoscopic evaluation. ⋯ The typical eosinophilic oesophagitis patient is a young adult man, often with an atopic constitution, who has intermittent symptoms of dysphagia. The diagnosis of 'eosinophilic oesophagitis' is based on characteristic histological findings in the oesophagus, seen in a fitting clinical context. Best evidence for the effects of treatment of eosinophilic oesophagitis is available for topical glucocorticoids.
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Ned Tijdschr Geneeskd · Jan 2012
Review[Down with odds ratios: risk ratios in cohort studies and randomised clinical trials].
Various effect measures are available for quantifying the relationship between an intervention or a risk factor and an outcome, such as the risk ratio and the odds ratio. Odds ratios are intended for use in case-control studies in which they are an appropriate measure for estimating the relative risk; however, this measure is also often presented in cohort studies and in randomized clinical trials. ⋯ For cohort studies and randomized clinical trials, however, there are methods to estimate adjusted risk ratios; these include the Mantel-Haenszel method, log-binomial regression, Poisson regression with robust standard error, and 'doubling of cases' method with robust standard error. To avoid misinterpretation of odds ratios, risk ratios should be calculated in cohort studies and randomized clinical trials.
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Vaccination against the human papilloma virus (HPV) has been included in the national Vaccination Programme of the Netherlands for 12-year-old girls since 2010. Vaccination coverage for the birth cohort of 1997 was 56.; there is a gradual increase in uptake. Continuous safety monitoring brought no new unknown serious side effects to light; many girls suffered from transient symptoms such as painful arm, fatigue and headache. ⋯ HPV vaccination of 12-year-old girls is cost-effective, even for relatively low vaccination coverage. The potential protection of HPV vaccination extends beyond prevention of cervical cancer by preventing other oncological manifestations of HPV infection in women as well as men and genital warts. The preventive HPV vaccines do not appear to be effective in treating existing abnormalities.