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donderdag 23 maart 2017

The Lancet: [Seminar] Hypothyroidism

[Seminar] Hypothyroidism
Hypothyroidism is a common condition of thyroid hormone deficiency, which is readily diagnosed and managed but potentially fatal in severe cases if untreated. The definition of hypothyroidism is based on statistical reference ranges of the relevant biochemical parameters and is increasingly a matter of debate. Clinical manifestations of hypothyroidism range from life threatening to no signs or symptoms. The most common symptoms in adults are fatigue, lethargy, cold intolerance, weight gain, constipation, change in voice, and dry skin, but clinical presentation can differ with age and sex, among other factors.
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[Comment] Computerised cardiotocography—study design hampers findings
Cardiotocography is a diagnostic tool, not a therapeutic modality. Diagnostic tests are unlikely to improve outcomes unless followed by specific and effective therapeutic interventions. When the management of highly specific abnormalities is not specified in a study protocol but is instead left to the individual discretion of many providers with very different management approaches, the chance that all of them will react in the same way is small.
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[Correspondence] The INFANT study— a flawed design foreseen
During the INFANT Study1 (March 21) application process in 2006–07 and since, concerns were formally raised regarding study design weaknesses by myself and some of the clinical investigators, clinical collaborators, and the National Institute for Health Research (NIHR) referees.2 The source of the concerns were two-fold.
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[Articles] Computerised interpretation of fetal heart rate during labour (INFANT): a randomised controlled trial
Use of computerised interpretation of cardiotocographs in women who have continuous electronic fetal monitoring in labour does not improve clinical outcomes for mothers or babies.
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[Articles] First-line rituximab combined with short-term prednisone versus prednisone alone for the treatment of pemphigus (Ritux 3): a prospective, multicentre, parallel-group, open-label randomised trial
Data from our trial suggest that first-line use of rituximab plus short-term prednisone for patients with pemphigus is more effective than using prednisone alone, with fewer adverse events.
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