Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
Review[Neuromodulation as a treatment for overactive bladder syndrome].
Neuromodulation is used as a treatment for overactive bladder syndrome, if conservative management is ineffective or only partially effective. Sacral neuromodulation is now a minimally invasive treatment as a result of improvements in surgical technique, and it has good long-term results. ⋯ Intravesical injection therapy with botulinum toxin, along with sacral neuromodulation, has been included in the treatment algorithm of overactive bladder syndrome if this does not respond to conservative therapy. When choosing for a neuromodulation therapy, the side-effects and complications of the treatments should be considered alongside the specific patient situation and evidence for effectiveness and long-term effectiveness.
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Since 2011, cobalt and chromium blood levels are measured in patients with a metal-on-metal hip implant (MoM prosthesis). In this article we discuss the health risks that are related to chronically elevated blood cobalt concentrations induced by abnormal wear and corrosion of the MoM prosthesis. Only a few patients who have systemic symptoms of poisoning, besides local symptoms around the failing MoM prosthesis, have been described in the literature. ⋯ In patients with a normal kidney function, the cobalt blood levels rapidly decrease and symptoms of cobalt intoxication subside. Chelation therapy should be restricted to those patients who are unable to undergo removal of the prosthesis immediately due to their medical condition. This can for example be because of a severe cobalt-induced cardiomyopathy.
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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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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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Ned Tijdschr Geneeskd · Jan 2012
Multicenter Study[Breast-conserving surgery for breast cancer: still much to be gained].
To conduct qualitative research into breast-conserving surgery for palpable and non-palpable breast tumours and the various methods of excising these, measured by the volume exised and surgical radicality. ⋯ Breast-conserving surgery is associated with an average of a 2 to 4-fold removal of excessive tissue. Nevertheless, 1 out of 5 excisions are not radical. Ultrasound-guided surgery for non-palpable breast cancer is the most effective method for achieving radical excision. A multicentre, prospective, randomised trial has been started to assess whether ultrasound-guided lumpectomy for palpable breast cancer can lead to optimisation of the excision volume and radicality.