Nederlands tijdschrift voor geneeskunde
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In medical research missing data are sometimes inevitable. Different missingness mechanisms can be distinguished: (a) missing completely at random; (b) missing by design; (c) missing at random, and (d) missing not at random. If participants with missing data are excluded from statistical analyses, this can lead to biased study results and loss of statistical power. ⋯ The most common imputation methods assume that missing data are missing at random. Multiple imputation contributes greatly to the efficiency and reliability of estimates because maximum use is made of the data collected. Imputation is not meant to obviate low-quality data.
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Transfusion-related acute lung injury (TRALI) is a major complication of blood transfusions. The pathogenesis of TRALI is thought to occur in 2 phases: the 'double-hit theory'. The first phase is an underlying condition present in the patient, such as a surgical procedure or sepsis, which leads to priming, i.e. the activation of endothelium and subsequent sequestration of neutrophils in the lungs. ⋯ The incidence of TRALI in patients with an underlying condition is high; up to 15% of transfused patients are at risk. Anti-HLA and anti-HNA antibodies are highly prevalent in multiparous female donors. The exclusion of female donors for plasma and thrombocyte products has led to a 33-66% reduction in the incidence of TRALI.
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Ned Tijdschr Geneeskd · Jan 2013
Comment[New practice guideline for spine related low back pain; anesthesiologists use a different classification system than general practitioners].
The practice guideline 'Invasive treatment of spine related low back pain' was recently released by the Netherlands Society of Anesthesiologists. This guideline evaluates the state of the art regarding the diagnosis and value of invasive treatment for facet joint pain, pain in the sacroiliac joint, coccygodynia, discogenic pain and the 'failed back surgery syndrome'. ⋯ The guideline was created in a methodologically sound manner, but the results are disappointing: the evaluated diagnoses remain disputable and the recommendations for the evaluated treatments are mostly based on expert opinion. The guideline lacks information on the scientific basis of the proposed new classification system, which makes its clinical usefulness questionable.
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Ned Tijdschr Geneeskd · Jan 2013
Case Reports[The Morel-Lavallée-lesion: delayed symptoms after trauma].
The Morel-Lavallée lesion is a post-traumatic collection of fluid arising after a 'closed degloving injury' has caused the separation of the skin and subcutis from the underlying muscular fascia. It usually occurs in the trochanteric region or proximal thigh. ⋯ A Morel-Lavallée lesion, which could manifest even months later, should be considered after any traumatic injury. Ultrasound, CT and MRI are useful tools for proper diagnosis. There is no consensus about treatment in either the acute or the chronic phase to date.
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Ned Tijdschr Geneeskd · Jan 2013
[Five years of European regulation on medication use in children: what has been achieved?].
It is not known if many existing medications can safely be used in children. For this reason the EU Paediatric Regulation came into force in 2007. When new medications are developed, pharmaceutical companies are obliged to produce a plan to research their use in children which must be approved by the regulatory authorities. ⋯ The use of 10 of the 113 new, previously unregistered medications in children was approved, as was the case with 30 registered medications. Examination of existing data shows that results are often limited to changes in the 'Summary of Product Characteristics'. Many planned studies still have to be wound up, but in time the amount of information on safety and efficacy of new medications in children will increase greatly.