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Over the last decade, the status of the randomized controlled trial (RCT), hallmark of evidence-based medicine (research), has been growing strongly in general practice, social work and public health. But this type of research is only practicable under strictly controlled and well-defined settings and conditions. In addition, persons are randomly assigned to experimental and control groups. However, in the daily practice of social work and public health professionals, this type of research is hardly feasible. Moreover, due to political, legal or ethical considerations, random selection or assignment will often be impossible. It is argued that the external validity of research outcomes will suffer from many of the features of the control in classic explanatory RCTs, not only for population-level interventions, but these outcomes will also be only marginally useful for deriving guidelines for professional practices and activities. Another big disadvantage of the RCT supremacy is the gap - i.e., loss of time and information - between research and practice, as illustrated by the ‘pipeline fallacy’ metaphor. In short, RCT may be the gold standard of study design in (bio) medical research, but it is often not feasible, ethical, or generalizable in the context of practice-based or practically-oriented research. In recent years, the appreciation and use of alternative research designs and data sources - that will overcome the disadvantages and limitations of RCTs - have increased. The article concludes with the description of alternatives to the classic explanatory RCT, i.e., methodological remedies for practice-based research with less emphasis on internal and more emphasis on external validity.

In het tijdperk van evidence-based practice (EBP) lijkt weinig twijfel te bestaan over het belang van het gebruik van onderzoek en onderzoeksgegevens in het uitwerken, de uitvoering en de evaluatie van beleidsmaatregelen, interventies en methodiekontwikkeling. Professionals uit de sectoren zorg, welzijn en cultuur moeten zich de nodige vaardigheden eigen maken om hun acties en interventies op basis van onderzoek te ontwerpen en uit te voeren en daarnaast de nodige kritische zin ontwikkelen voor het interpreteren van (nieuwe) onderzoeksresultaten. Anderzijds moeten vanuit de wetenschappelijke wereld inspanningen worden geleverd om nieuwe inzichten te vertalen naar de praktijk van de sector, antwoorden te formuleren op vragen uit de praktijk, dus praktijkgericht onderzoek uit te voeren. Een cruciale vraag is hoe dergelijk onderzoek er moet uitzien en aan welke criteria het moet voldoen.

In het basisonderwijs is 19% van de docenten man en in de kinderopvang is slechts 4% van de pedagogisch medewerkers man. Wat de gevolgen zijn van deze relatief lage percentages mannen, vooral in de kinderopvang, voor de ontwikkeling van jongens en meisjes is echter nog nooit wetenschappelijk onderzocht.

Thoracic Sympathectomy, although currently less frequently performed, has nevertheless some well defined indications, such as primary hyperhidrosis of the upper extremity. Videothoracoscopic method is also particularly appealing in these procedures for its less invasive approach, allowing a favourable operative view. Materials and Methods - In order to define the indications and to analyze the results, based on literature data and personal experience, we have examined the advantages and limits of Videothoracoscopic Sympathectomy Procedure. Our experience is consistent with 14 procedures in 7 patients; in all cases we used three intercostal thoracoports through which, with 5 o 10 mm optic, we performed a sub-pleural resection of the sympathetic chain selected segment. Discussion and Conclusions - In our initial experience we obtained good clinical results as compared to those reported in literature. Nowadays we consider the thoracoscopic approach as the first choice when performing thoracic sympathectomy.

Hypes bestrijden? Prima! Onze invalshoek bij de recente ontdekkingen uit de neuro- en biopsychologie is vooral om te kijken wat we er wel en wat we er niet aan hebben. Inzicht in de ontwikkeling van het brein is op de eerste plaats relevant voor het vergroten van inzicht in de totstandkoming van verschillende ontwikkelingstrajecten zoals die van jongens en meisjes.

Objectives: The International Registry of Lung Metastases was established in 1991 to assess the long-term results of pulmonary metastasectomy. Methods: The Registry has accrued 5206 cases of lung metastasectomy, from 18 departments of thoracic surgery in Europe ( n = 13), the United States ( n = 4) and Canada ( n = 1). Of these patients, 4572 (88%) underwent complete surgical resection. The primary tumor was epithelial in 2260 cases, sarcoma in 2173, germ cell in 363, and melanoma in 328. The disease-free interval was 0 to 11 months in 2199 cases, 12 to 35 months in 1857, and more than 36 months in 1620. Single metastases accounted for 2383 cases and multiple lesions for 2726. Mean follow-up was 46 months. Analysis was performed by Kaplan-Meier estimates of survival, relative risks of death, and multivariate Cox model. Results: The actuarial survival after complete metastasectomy was 36% at 5 years, 26% at 10 years, and 22% at 15 years (median 35 months); the corresponding values for incomplete resection were 13% at 5 years and 7% at 10 years (median 15 months). Among complete resections, the 5-year survival was 33% for patients with a disease-free interval of 0 to 11 months and 45% for those with a disease-free interval of more than 36 months; 43% for single lesions and 27% for four or more lesions. Multivariate analysis showed a better prognosis for patients with germ cell tumors, disease-free intervals of 36 months or more, and single metastases. Conclusions: These results confirm that lung metastasectomy is a safe and potentially curative procedure. Resectability, disease-free interval, and number of metastases enabled us to design a simple system of classification valid for different tumor types. (J Thorac Cardiovasc Surg 1997;113:37-49)

Neuroendocrine tumors of the lung involve an heterogeneous group of tumors representing a wide range of histological variants, from well-differentiated typical carcinoid (TC) tumors to poorly differentiated small cell carcinomas. The epidemiology, clinical outcome, and management of these neoplasms differ significantly from other lung malignancies. The main aim of this report consists in describing the single Center experience of the Istituto Nazionale Tumori of Milan on neuroendocrine lung tumors, with an emphasis on bronchopulmonary carcinoid subtypes. From 1986 to 2009, 91 cases of carcinoid tumors were diagnosed; these were divided in two series, according to typical (66 patients) or atypical [25] histotypes. These two groups were compared in relation to various features, including pathologic classification, clinical behavior, treatment modalities and long-term survival. At the moment of diagnosis 11 patients had locally advanced/metastatic disease, while 80 patients showed non metastatic disease. The comparative analysis between typical and atypical series disclosed significant differences in terms of long-term survival; in fact, 5-year and 10-year survival rates were 98 % and 94 % for the first carcinoid series versus 76 % and 18 % for the atypical series, respectively (p