Biomedical subjects

J J E van Everdingen

Publications and source records attributed to J J E van Everdingen.

9 recordsLinked to original sources

PubMed2006

[Levels of evidence value are useful in the evaluation of studies and results].

A classification of scientific evidence into 'levels', in which the type of research design is graded according to its strength, is useful because it helps the medical community to sort out a system that is accepted all over the world. It not only makes the highest levels of evidential value explicit for a particular clinical question, but also makes the lack of evidence visible. Selected articles will contain labels identifying the strength of evidence supporting key recommendations.

Evidence-Based Medicine↗

PubMed2006

[The practice guideline 'vitiligo'].

A working group of the Dutch Society for Dermatology and Venereology (NVDV), in collaboration with the Dutch Institute for Health Care Improvement (CBO), has written an evidence-based guideline for the treatment of vitiligo. A distinction is made between generalised or non-segmental vitiligo and localised, including segmental, vitiligo. In patients with generalised vitiligo phototherapy (especially narrow-band ultraviolet B) is the treatment of first choice while in localised vitiligo, this is surgery, particularly autologous skin transplantation (Thiersch grafting, the use of blister epidermis and cell suspensions). However, on the basis of the results of the treatments proposed in the guideline, the working group cannot advise dermatologists to propose a particular treatment to each vitiligo patient they see. On the other hand, the working group is of the opinion that, based on a proper medical examination and an assessment of the disease burden, well-considered advice--and in some cases therapy--should be given to every vitiligo patient who requests it. The benefit of the guideline is that it provides clarity to dermatologists, general practitioners and patients regarding the therapeutic possibilities and limitations.

Diagnosis, Differential↗

PubMed2005

[Guideline 'Melanoma' (3rd revision)].

The guidelines 'Melanoma' (3rd revision) are evidence-based in nature. A number of outcomes are summarised in this article. Dermatoscopy deserves a standard role in the clinical diagnosis of pigmented skin abnormalities. Pathological findings from a diagnostic excision should be recorded meticulously to include anatomical localisation, type of intervention used, excision margin, diagnosis, Breslow thickness, and the completeness of the removal. The sentinel node procedure should be reserved for patients who want to be as informed as possible about their prognosis. The procedure is not considered a part of standard diagnosis. Sentinel node assessment should include stains for specific markers and should be conducted in multiple sections. The following margins of non-affected skin are recommended for therapeutic re-excision of melanoma: in situ melanoma, 0.5 cm; Breslow thickness < or = 2 mm, 1 cm; Breslow thickness > 2 mm, 2 cm. Pathological assessment of a re-excised specimen depends on the completeness of the first excision. Systematic adjuvant treatment of patients with melanoma is not recommended outside the context of a clinical study. Patients with metastatic melanoma are preferably treated within a clinical study. Outside of a clinical study, these patients should be treated with dacarbazine. There is no evidence to suggest that survival is improved by frequent follow-up. However, follow-up can be a useful way to meet the information needs of patients and care requirements for physicians.

Dermatology↗

PubMed2005

[Evidence-based guidelines in the organization of medical care].

Organizational as well as managerial aspects can influence the outcome of patient care, in the establishment of a stroke service unit for instance. Critics wonder whether organisational aspects should be excluded from evidence-based guidelines as strong evidence is often lacking and managers are not included in the working party. It can be argued that it is neither the outcome nor the strength of the published evidence that determines whether a guideline is evidence-based but the method of guideline development. This includes a systematic search and critical appraisal of the literature as well as a rigorous external review in order to achieve consensus on statements including those pertaining to organization of care, for which evidence is poor or lacking.

Benchmarking↗

PubMed2005

[The new medical oath in The Netherlands].

The Hippocratic oath derives its name from the ancient Greek physician Hippocrates. It has been embraced as a code of conduct by the medical profession throughout the ages, and is used by medical faculties as an explicit moment of reflection during graduation ceremonies. Although this oath is primarily of ceremonial value, it was felt that the text needed revision as it no longer reflected the current ethical norms in the Netherlands. The new Dutch oath drawn up in 2003 has a dual function: it is symbolic in that it represents the end of a doctor's training, but it is also intended to trigger the discussion of moral issues during the medical studies.

Bioethics↗

PubMed2005

[The risk of pelvic inflammatory disease associated with urogenital infection with Chlamydia trachomatis; literature review].

OBJECTIVE: To determine the rate of PID in women with genital Chlamydia trachomatis infection. DESIGN: Systematic literature review. METHOD: MEDLINE and EMBASE were searched over the years 1975-2003 using the keywords 'Chlamydia trachomatis', 'complication', 'pelvic (inflammatory disease)', 'PID', 'endometritis', 'adnexitis', and 'salpingitis'. The reference lists ofthe articles retrieved were checked for other relevant publications. The PID complication rate was determined, as were the characteristics of the study populations and the validity of the diagnostic methods and outcome measures used. RESULTS: 9 prospective studies were identified. The rate of PID in women with a genital C. trachomatis infection varied between o and 72%. Asymptomatic women who were diagnosed with C. trachomatis infection in general screening had the lowest rate of PID: 0-4%. PID occurred in 12-30% of symptomatic women or women with a higher risk of having an STD (e.g. visitor of an STD clinic, double-infection with gonorrhoea, high risk assessed by questionnaire, having a partner with symptomatic C. trachomatis infection). Women who underwent legal abortion had the highest rate of PID (27-72%). CONCLUSION: The PID rate in women with C. trachomatis varied considerably. Risk depended on whether the infection was symptomatic and the prior probability of having an STD.

Adult↗

PubMed2004

[The practice guideline 'Photo(chemo)therapy and systemic therapy in severe chronic plaque-psoriasis'].

The guideline for the treatment of adults with moderate to severe chronic plaque-type psoriasis vulgaris is based on published scientific evidence. The efficacy of the treatment, its safety, the side effects, the patients' discomfort, the patients' preference and the costs of treatment and follow-up are listed as criteria that play a role in the choice of treatment. Photo(chemo)therapy is the treatment of choice for severe forms of psoriasis. Phototherapy with ultraviolet-B light (UVB), especially narrow-band UVB, is preferred above photochemotherapy with ultraviolet-A light and psoralenes (PUVA). Of the oral treatments, methotrexate and ciclosporin are preferred above retinoids and fumarates because they yield a higher percentage of patients with partial or nearly complete remission. Fumarates are not officially registered in The Netherlands and Belgium.

Cyclosporine↗

PubMed2004

[Evidence-based guideline development in the Netherlands: the EBRO platform].

In the Netherlands many institutes, associations and professional organisations are active in the development of guidelines for clinical practice. In 1997, the Dutch Cochrane Centre and the Dutch Institute for Healthcare Improvement (CBO) took the initiative and set up a national platform of guideline organisations (currently 28 in number) with the aim of harmonising methodology and promoting evidence-based guideline development. In 2003 the Guidelines International Network (G-I-N) was founded with similar goals but at international level. The Dutch platform (EBRO) offers the opportunity to establish a network that will plan and execute guideline development and updating. This will prevent duplication of efforts and controversy between stakeholders. Another task will be the promotion and transfer of knowledge on evidence-based guideline development by organising conferences and educational programmes. The ultimate goal is to support health-care providers in improving quality of patient care.

Education, Medical↗

PubMed2002

[Systematic reviews in practice. IX. Determining their place in treatment recommendations in practice guidelines].

In a systematic review (SR), the available evidence for a clinical problem is systematically and comprehensively collected from different studies, the likelihood of bias is assessed and the results are summarised in a reproducible manner. The results of an SR can be used in either individual patient care or the formulation of a practice guideline. Throughout the world, (national) organisations for guideline development use systems for classifying the validity of evidence according to the study design ('levels of evidence'), and this is also the case in the Netherlands. In formulating a treatment recommendation, consideration must be given to the various factors which determine the strength of the evidence: study design, consistency of the results (if more studies are available), quality of the individual studies, magnitude and precision of the reported effect and the clinical relevance of the outcome measures. If insufficient studies with the same outcome measure are available, problems can arise in an SR. In practice, problems can also arise with respect to estimating the cogency of an SR compared to another review or primary studies. For the same subject, there might be discordant reviews, differences between reviews and megatrials might exist or just one randomised clinical trial might be available. These problems can often be solved with the aid of a systematic analysis. This requires both methodological and clinical expertise.

Bias↗