Beyond the evidence of guidelines.

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Nijmeegse Lessen.

Contains fulltext : 71065.pdf (publisher's version ) (Open Access

[Hyponatremia caused by thiazide diuretics: be aware of drug combinations which enhance this effect]

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Consensus non-invasieve diagnostiek van perifere arteriele vaatziekte

Contains fulltext : 21770___.PDF (publisher's version ) (Open Access

Raynaud's phenomenon: clinical, pathophysiological and therapeutical studies

Contains fulltext : mmubn000001_065731727.pdf (publisher's version ) (Open Access)Promotor : A. van ’t Laar188 p

Double-blind, placebo-controlled study of intravenous prostacyclin on hemodynamics in severe Raynaud's phenomenon: the acute vasodilatory effect is not sustained

Contains fulltext : 21840___.PDF (publisher's version ) (Open Access

Clinical guidelines to improve patient care.

Contains fulltext : 48763.pdf (publisher's version ) (Open Access)The aim of clinical guidelines is to improve quality of care by translating new research findings into practice. There is evidence that the following characteristics contribute to their use: inclusion of specific recommendations, sufficient supporting evidence, a clear structure and an attractive lay out. In the process of formulating recommendations, implicit norms of the target users should be taken into account. Guidelines should be developed within a structured and coordinated programme by a credible central organisation. To promote their implementation, guidelines could be used as a template for local protocols, clinical pathways and interprofessional agreements

A systematic review on the influence of trial quality on the effect of garlic on blood pressure.

Contains fulltext : 79686.pdf (publisher's version ) (Open Access)BACKGROUND: Garlic is a widely used herbal product for hypertension. Previous meta-analyses on the effect of garlic on blood pressure (BP) have been contradictory however. We hypothesised that methodological deficiencies may have contributed to this disagreement. We therefore evaluated whether trials reporting on the effect of garlic on BP had sufficient methodological qualities and a proper description of BP determination. METHODS: MEDLINE , EMBASE, AMED, the COCHRANE library, IBIDS and CINA HL were systematically searched for trials reporting on the effect of garlic on BP. Both the methodological quality and the quality of blood pressure measurement were appraised using predefined quality scores. RESULTS: 32 Studies were identified. Of these studies, 13 were included previously by other meta-analyses. The methodological quality of the studies was poor. Only four trials had adequate allocation concealment, no single trial reported an intention-to-treat analysis and blinding of the evaluators was done in three trials only. Moreover, half of the studies did not report any data on BP measurement. No trials reported on the arm level. Body position was described most often. All trials fulfilling a predefined cutoff point were conducted in normotensive subjects. CONCLUSION: The effect of garlic on blood pressure cannot be ascertained. Previous meta-analyses have been based on trials with inadequate study designs, methodological deficiencies and with too little information about blood pressure measurement. In our view, use of garlic cannot be recommended as antihypertensive advice for hypertensive patients in daily practice