Kwalitatieve analyse: uitgangspunten en procedures

Item does not contain fulltextOver kwalitatief onderzoek is de laatste jaren veel gepubliceerd, zowel op inleidend als op specialistisch niveau. Daarnaast is er een enorme ontwikkeling geweest op het gebied van elektronische tekstverwerking en van programmatuur voor kwalitatieve analyse. Een probleem van het werken met standaardprogramma's is dat de gebruiker uit het oog verliest waar hij bij kwalitatief analyseren om gaat: het maken van een systematische analyse door een diepgaande verkenning van het basismateriaal. Vanuit deze optiek behandelen de auteurs Wester en Peters het kwalitatief-interpreterende onderzoek. Daarbij wordt aandacht besteed aan de uitgangspunten voor kwalitatief onderzoek, de keuzes met betrekking tot de onderzoeksopzt, de mogelijkheden van waarneming, de doelstellingen van de analysefasen en de kwaliteitscontroles. Binnen die context komen de concrete werkwijze in de analyse en de mogelijke rol van de computer daarbij aan bod.220 p

De computer bij kwalitatief-interpreterend onderzoek: Een onderzoeksnotitie

Item does not contain fulltextIn the last decade, many publications have been devoted to the methodology of qualitative analysis. Here, the role of the computer in the process of qualitative analysis is discussed. With the grounded theory approach as a methodological background, a stepwise procedure is proposed for the analysis of qualitative (textlike) data

Qualitative analysis: Phases, techniques and computer use

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Whipple's disease: a difficult diagnosis?

Whipple's disease: a difficult diagnosis? Peters FP, Elbrecht EA, Wouters RS, Engels LG, Stockbrugger RW. Department of Gastroenterology, University Hospital Maastricht, Netherlands. We present 3 patients with Whipple's disease all characterized by a longstanding prodromal period with progressive weight loss, diarrhoea, lymphadenitis and arthralgia or arthritis. Sarcoid-like Whipple's disease was diagnosed in one patient. He was treated with antibiotics. Initially his condition improved; however, a cerebral relapse developed which was treated successfully by ceftriaxone and cefixime. Extraintestinal Whipple's disease (lymph node localisation) was diagnosed in another patient treated successfully with antibiotics. A third case of Whipple's disease was unexpectedly diagnosed by laparotomy and partial small bowel resection. He was not treated till 2 years later with tetracycline. After 1 year of treatment his condition had improved. Publication Types: Case Reports Review Review, Tutoria

Impact of the COVID-19-pandemic on patients with gynecological malignancies undergoing surgery: A Dutch population-based study using data from the ‘Dutch Gynecological Oncology Audit’

Objective: The COVID-19-pandemic caused drastic healthcare changes worldwide. To date, the impact of these changes on gynecological cancer healthcare is relatively unknown. This study aimed to assess the impact of the COVID-19-pandemic on surgical gynecological-oncology healthcare. Methods: This population-based cohort study included all surgical procedures with curative intent for gynecological malignancies, registered in the Dutch Gynecological Oncology Audit, in 2018–2020. Four periods were identified based on COVID-19 hospital admission rates: ‘Pre-COVID-19’, ‘First wave’, ‘Interim period’, and ‘Second wave’. Surgical volume, perioperative care processes, and postoperative outcomes from 2020 were compared with 2018–2019. Results: A total of 11,488 surgical procedures were analyzed. For cervical cancer, surgical volume decreased by 17.2% in 2020 compared to 2018–2019 (mean 2018–2019: n = 542.5, 2020: n = 449). At nadir (interim period), only 51% of the expected cervical cancer procedures were performed. For ovarian, vulvar, and endometrial cancer, volumes remained stable. Patients with advanced-stage ovarian cancer more frequently received neoadjuvant chemotherapy in 2020 compared to 2018–2019 (67.7% (n = 432) vs. 61.8% (n = 783), p = 0.011). Median time to first treatment was significantly shorter in all four malignancies in 2020. For vulvar and endometrial cancer, the length of hospital stay was significantly shorter in 2020. No significant differences in complicated course and 30-day-mortality were observed. Conclusions: The COVID-19-pandemic impacted surgical gynecological-oncology healthcare: in 2020, surgical volume for cervical cancer dropped considerably, waiting time was significantly shorter for all malignancies, while neoadjuvant chemotherapy administration for advanced-stage ovarian cancer increased. The safety of perioperative healthcare was not negatively impacted by the pandemic, as complications and 30-day-mortality remained stable

Whipple's disease revisited

Whipple's disease has traditionally been considered to be a rare multisystem disorder dominated by malabsorption. The recent identification of the Whipple's disease bacillus has, using polymerase chain reaction based assays, fuelled advances in the investigation, diagnosis, and management of this disease. This leader reviews the aetiology, clinical manifestations, investigation, and treatment of Whipple's disease in the light of this new information. Key Words: Tropheryma whippelii • immune system • polymerase chain reactio

Postoperative outcomes of primary and interval cytoreductive surgery for advanced ovarian cancer registered in the Dutch Gynecological Oncology Audit (DGOA)

Objectives: The challenge when performing cytoreductive surgery (CRS) is to balance the benefits and risks. The aim of this study was to report short term postoperative morbidity and mortality in relation to surgical outcome in patients undergoing primary debulking surgery (PDS) or interval debulking (IDS) surgery in the Netherlands. Methods: The Dutch Gynecological Oncology Audit (DGOA) was used for retrospective analysis. Patients undergoing PDS or IDS between January 1st, 2015 - December 31st, 2018 were included. Outcome was frequency of postoperative complications. Median time to adjuvant chemotherapy and severity of complications were related to outcome of CRS. Complications with Clavien-Dindo ≥3 were analyzed per region and case mix corrected. Statistical analysis was performed with R.Studio. Results: 1027 patients with PDS and 1355 patients with IDS were included. Complications with re-invention were significantly higher in PDS compared to IDS (5.7% vs. 3.6%, p = 0.048). Complete cytoreduction was 69.7% in PDS and 62.1% IDS, p &lt; 0.001. Time to adjuvant chemotherapy was 49 days in patients with complete CRS and a complication with re-intervention. Regional variation for severe complications showed one region outside confidence intervals. Conclusions: Higher complete cytoreduction rate in the PDS group indicates that the correct patients have been selected, but is associated with a higher percentage of complication with re-intervention. As result, time to start adjuvant chemotherapy is longer in this group. Maintaining a balance in aggressiveness of surgery and outcome of the surgical procedure with respect to severe complications is underlined. Bench marked data should be discussed nationally to improve this balance.</p