Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
[Dutch military casualties of the war in Afghanistan--quality of life and level of participation after rehabilitation].
To describe the distribution of injuries and the quality of life and functioning at activity and participation level of rehabilitated Dutch military personnel who were wounded during the mission to Afghanistan. ⋯ The quality of life and functional level of Dutch military personnel who were injured in combat in Afghanistan seemed to be lower than in the general population after 2.3 years. For a large part this could be explained by the level of mobility and occupation.
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Many medical doctors have become famous writers or poets. The two professions do have similarities: both have a professional preference for people in a crisis situation, both need to come close to their subject while maintaining a certain distance, the relationship between the individual and the general plays a central role in the practice of medicine and writing, writing and healing are similar in many ways and stories play an important role for both doctors and writers. We discuss these similarities in this article.
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The first case report describes an extremely prolonged activated partial thromboplastin time (APTT) in a patient with no history of increased bleeding tendency. Heparin use was excluded. The APTT mixing study combined with the medical history suggests a deficiency in one of the non-essential coagulation factors. ⋯ Aberrations in the process of haemostasis can be efficiently screened using a platelet count, an APTT, a PT and a thorough physical examination combined with a thorough medical history taking. Common causes of prolonged PT and/or APTT are the use of oral anticoagulants or heparin, vitamin K deficiency and liver disease. Other causes include coagulation factor deficiencies, coagulation factor inhibitors and diffuse intravascular coagulation.
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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.