A significant proportion of the in-hospital antimicrobial consumption is used in the empiric setting, making empiric therapy an important target of stewardship interventions.Empiric antimicrobial... Show moreA significant proportion of the in-hospital antimicrobial consumption is used in the empiric setting, making empiric therapy an important target of stewardship interventions.Empiric antimicrobial therapy is the antimicrobial regimen that is started when the definite clinical diagnosis, causative agent and/or resistance pattern are yet unknown. Empiric therapy is accompanied by a varying level of uncertainty. In daily clinical practice, this uncertainty about the source, pathogen and susceptibility pattern are often managed by prescribing relatively broad-spectrum antimicrobial therapy. This has potential negative effects, such as toxicity and selective pressure resulting in antimicrobial resistance. Balancing the potential benefits and drawbacks of more broad-spectrum therapy is a substantial challenge, in particular when the level of uncertainty is high.This thesis aims to address the uncertainties most relevant in daily clinical practice in empiric antimicrobial therapy, to determine how they affect daily decision making, and to explore how this can be translated in antimicrobial policy making and antimicrobial stewardship. Show less
This thesis is about ethics and neonatal resuscitation. More specifically, this thesis discussed ethical challenges that are raised after the decision to provide active care, when neonatal care... Show moreThis thesis is about ethics and neonatal resuscitation. More specifically, this thesis discussed ethical challenges that are raised after the decision to provide active care, when neonatal care providers strive to provide the best possible care. The provision of the best possible care during neonatal resuscitation can be assured throughconducting research and quality improvement activities. However, conducting these activities can be ethically challenging. By combining empirical research with ethicalreasoning, this thesis aimed to provide guidance for the ethical conduct of activities to study and improve neonatal resuscitation. Show less
Patient outcomes have been tremendously improved through neurosurgical innovation for which there are countless examples. However, how neurosurgical innovation occurs generally lacks structure.... Show morePatient outcomes have been tremendously improved through neurosurgical innovation for which there are countless examples. However, how neurosurgical innovation occurs generally lacks structure. This lack results in several ethical and practical problems related to patient safety. In this thesis, a new framework for neurosurgical innovation is proposed. This framework aims to provide an adequate valuation of structured and careful innovation. In recent neurosurgical innovations, related ethical dillema’s and excisiting frameworks for innovation were evaluated to come to this framework.Based on an extensive review of the literature, several recent neurosurgical innovations were not introduced in a structured fashion. This unstructured introduction holds potentially far-reaching consequences for informed consent, patient safety, and knowledge regarding long-term outcomes.Neurosurgical innovation holds several ethical dilemmas. These dilemmas range from the need to innovate in an emergency setting to the learning curve that every novel procedure brings. This thesis describes these dilemmas in detail and discusses potential solutions.Existing frameworks for innovation in medicine, such as the IDEAL Framework and learning health systems, have limited application to neurosurgery because of its unique patient population. Nevertheless, these frameworks form the inspiration for the beforementioned newly suggested framework for neurosurgical innovation. Show less
