By comparing treatment for displaced intraarticular calcaneal fractures with treatment for orthopaedic problems or other disease processes, we concluded that intraarticular calcaneal fractures are serious life-changing events.

THL is a feasible technique. Its capacity to predict spontaneous ongoing pregnancy is comparable to that of laparoscopy.

The Chlamydia antibody titre (CAT) is a test used to identify subfertile couples at increased risk for tubal pathology. The usefulness of the routine performance of CAT was evaluated in a multicentre prospective cohort study, in women without regular ovulation. Consecutive couples presenting with subfertility due to an irregular menstrual cycle or amenorrhoea were included. A total of 711 women were studied, all of whom underwent CAT. Tubal status was verified in 190 of these women. Two-sided tubal pathology was found in 5% of these women, and one-sided occlusion in 10%. Of all the women in the study group, 33 (4.6%) had an abnormal CAT, of which 21 underwent further tubal testing. Tubal pathology was found in two (10%) of these 21 patients. The sensitivity and specificity of CAT were respectively 20% and 89%. Correction for verification bias increased the specificity to 96% with a drop of the sensitivity to 9%. In subfertile couples with anovulation, the performance of CAT is not useful. It is proposed that testing for tubal disease in these women is delayed until treatment with clomiphene citrate has failed.

Evidence-based medicine (EBM) tries to integrate best research evidence with clinical expertise and patient values. Clinicians can use this method to provide their counseled patients with the best available evidence. The aim of the present article is to demonstrate the application of EBM in everyday practice. We present a case of a woman with subfertility due to polycystic ovary syndrome (PCOS) who was not responding to treatment with clomiphene citrate. Herein a search of the literature is discussed, and a randomised clinical trial assessing the effectiveness of a strategy starting with laparoscopic electrocoagulation (LEO) and gonadotrophins is scrutinised with regard to internal validity. Studies on treatment should be appraised regarding method randomisation, concealment of allocation, blinding or masking, comparability of the groups, completeness of follow-up, analysis according to the intention-to-treat principle, equality of treatment of both groups, and adequate sample size. The study reports both treatments to be equally effective with respect to ongoing pregnancy, which is the primary outcome. A strategy starting with LEO seems to be more cost-effective and reduces the number of multiple pregnancies, which are arguments in favour of it. These arguments should be weighed against individual characteristics such as the risk of laparoscopic surgery and individual patient preferences.