Nikolay Ivanovich Pirogov, one of the greatest Russian surgeons of the 19th Century, was convinced of the importance of deploying nurses to care for the casualties of war. With the support of Grand... Show moreNikolay Ivanovich Pirogov, one of the greatest Russian surgeons of the 19th Century, was convinced of the importance of deploying nurses to care for the casualties of war. With the support of Grand Duchess Elena Pavlovna, sister-in-law of Tsar Nikolas I, Pirogov realised the idea during the Crimean war when Russia became the first country to send female nurses to the battle front. Later in the 19th century, large numbers of Russian women trained as nurses under the auspices of the Russian Red Cross, founded in 1867. In peacetime, their expertise was extremely valuable. Show less
The 19th century Russian surgeon Nikolay Ivanovich Pirogov believed passionately in the importance of anatomy for surgeons. His interest in anatomy began as a medical student in Moscow. After... Show moreThe 19th century Russian surgeon Nikolay Ivanovich Pirogov believed passionately in the importance of anatomy for surgeons. His interest in anatomy began as a medical student in Moscow. After graduating in 1828 Pirogov entered the postgraduate German-Baltic University of Dorpat (now Tartu in the Republic of Estonia) where he studied anatomy and surgery. After completing his study, he remained to research the consequences of ligation of the aorta in a series of animal experiments, which formed the core of his doctoral thesis. He wanted to determine the feasibility of aortic ligation as a treatment for patients with an aneurysm of the aorta or iliac artery. He discovered that success was only likely when the aorta was ligated between the two mesenteric arteries and the ligature gradually tightened, an approach surgically difficult in humans. Pirogov then spent 2 years at the Charite Hospital in Berlin before returning to Russia. In 1841, he was appointed Professor of Applied Anatomy and Surgery at the Imperial Medico-Surgical Academy in Saint Petersburg. He instituted the teaching of microscopy and histology to the medical curriculum and in 1846 formed the Institute for Applied Anatomy within the academy, where in addition to teaching medical students future teachers of anatomy in Russia were trained. Pirogov published extensively on anatomy, including several anatomical atlases, the most notable his three-dimensional atlas of topographical anatomy published in four volumes between 1852 and 1859. Today Pirogov's contributions to anatomy are remembered in a number of anatomical structures named after him. Clin. Anat., 33:714-730, 2020. (c) 2019 Wiley Periodicals, Inc. Show less
Cammel, S.A.; Vos, M.S. de; Soest, D. van; Hettne, K.M.; Boer, F.; Steyerberg, E.W.; Boosman, H. 2020
Background Patient experience surveys often include free-text responses. Analysis of these responses is time-consuming and often underutilized. This study examined whether Natural Language... Show moreBackground Patient experience surveys often include free-text responses. Analysis of these responses is time-consuming and often underutilized. This study examined whether Natural Language Processing (NLP) techniques could provide a data-driven, hospital-independent solution to indicate points for quality improvement. Methods This retrospective study used routinely collected patient experience data from two hospitals. A data-driven NLP approach was used. Free-text responses were categorized into topics, subtopics (i.e. n-grams) and labelled with a sentiment score. The indicator 'impact', combining sentiment and frequency, was calculated to reveal topics to improve, monitor or celebrate. The topic modelling architecture was tested on data from a second hospital to examine whether the architecture is transferable to another hospital. Results A total of 38,664 survey responses from the first hospital resulted in 127 topics and 294 n-grams. The indicator 'impact' revealed n-grams to celebrate (15.3%), improve (8.8%), and monitor (16.7%). For hospital 2, a similar percentage of free-text responses could be labelled with a topic and n-grams. Between-hospitals, most topics (69.7%) were similar, but 32.2% of topics for hospital 1 and 29.0% of topics for hospital 2 were unique. Conclusions In both hospitals, NLP techniques could be used to categorize patient experience free-text responses into topics, sentiment labels and to define priorities for improvement. The model's architecture was shown to be hospital-specific as it was able to discover new topics for the second hospital. These methods should be considered for future patient experience analyses to make better use of this valuable source of information. Show less
The 19th century Russian surgeon Nikolay Ivanovich Pirogov believed passionately in the importance of anatomy for surgeons. His interest in anatomy began as a medical student in Moscow. After... Show moreThe 19th century Russian surgeon Nikolay Ivanovich Pirogov believed passionately in the importance of anatomy for surgeons. His interest in anatomy began as a medical student in Moscow. After graduating in 1828 Pirogov entered the postgraduate German-Baltic University of Dorpat (now Tartu in the Republic of Estonia) where he studied anatomy and surgery. After completing his study, he remained to research the consequences of ligation of the aorta in a series of animal experiments, which formed the core of his doctoral thesis. He wanted to determine the feasibility of aortic ligation as a treatment for patients with an aneurysm of the aorta or iliac artery. He discovered that success was only likely when the aorta was ligated between the two mesenteric arteries and the ligature gradually tightened, an approach surgically difficult in humans. Pirogov then spent 2 years at the Charité Hospital in Berlin before returning to Russia. In 1841, he was appointed Professor of Applied Anatomy and Surgery at the Imperial Medico-Surgical Academy in Saint Petersburg. He instituted the teaching of microscopy and histology to the medical curriculum and in 1846 formed the Institute for Applied Anatomy within the academy, where in addition to teaching medical students future teachers of anatomy in Russia were trained. Pirogov published extensively on anatomy, including several anatomical atlases, the most notable his three-dimensional atlas of topographical anatomy published in four volumes between 1852 and 1859. Today Pirogov’s contributions to anatomy are remembered in a number of anatomical structures named after him. Show less
Veek, S.M.C. van der; Haan, E. de; Derkx, H.H.F.; Benninga, M.A.; Boer, F. 2017
The effectiveness of cognitive behaviour therapy for paediatric functional abdominal pain leaves room for improvement. We studied which factors addressed in cognitive behaviour therapy relate most... Show moreThe effectiveness of cognitive behaviour therapy for paediatric functional abdominal pain leaves room for improvement. We studied which factors addressed in cognitive behaviour therapy relate most strongly to the physical and psychological functioning of children with functional abdominal pain and are thus most important to target. Questionnaires were filled out by 117 children with functional abdominal pain and their parents. Multiple regression analyses showed that children's passive coping and parental and children's positive cognitions relate to child functioning. Negative cognitions and parental solicitous behaviour were unrelated to child functioning. Cognitive behaviour therapy for functional abdominal pain may benefit most from changing children's passive coping and promoting positive cognitions. Show less
IMPORTANCE\nAlthough numerous children receive methylphenidate hydrochloride for the treatment of attention-deficit/hyperactivity disorder (ADHD), little is known about age-dependent and possibly... Show moreIMPORTANCE\nAlthough numerous children receive methylphenidate hydrochloride for the treatment of attention-deficit/hyperactivity disorder (ADHD), little is known about age-dependent and possibly lasting effects of methylphenidate on the human dopaminergic system.\nOBJECTIVES\nTo determine whether the effects of methylphenidate on the dopaminergic system are modified by age and to test the hypothesis that methylphenidate treatment of young but not adult patients with ADHD induces lasting effects on the cerebral blood flow response to dopamine challenge, a noninvasive probe for dopamine function.\nDESIGN, SETTING, AND PARTICIPANTS\nA randomized, double-blind, placebo-controlled trial (Effects of Psychotropic Drugs on Developing Brain-Methylphenidate) among ADHD referral centers in the greater Amsterdam area in the Netherlands between June 1, 2011, and June 15, 2015. Additional inclusion criteria were male sex, age 10 to 12 years or 23 to 40 years, and stimulant treatment-naive status.\nINTERVENTIONS\nTreatment with either methylphenidate or a matched placebo for 16 weeks.\nMAIN OUTCOMES AND MEASURES\nChange in the cerebral blood flow response to an acute challenge with methylphenidate, noninvasively assessed using pharmacological magnetic resonance imaging, between baseline and 1 week after treatment. Data were analyzed using intent-to-treat analyses.\nRESULTS\nAmong 131 individuals screened for eligibility, 99 patients met DSM-IV criteria for ADHD, and 50 participants were randomized to receive methylphenidate and 49 to placebo. Sixteen weeks of methylphenidate treatment increased the cerebral blood flow response to methylphenidate within the thalamus (mean difference, 6.5; 95% CI, 0.4-12.6; P = .04) of children aged 10 to 12 years old but not in adults or in the placebo group. In the striatum, the methylphenidate condition differed significantly from placebo in children but not in adults (mean difference, 7.7; 95% CI, 0.7-14.8; P = .03).\nCONCLUSIONS AND RELEVANCE\nWe confirm preclinical data and demonstrate age-dependent effects of methylphenidate treatment on human extracellular dopamine striatal-thalamic circuitry. Given its societal relevance, these data warrant replication in larger groups with longer follow-up.\nTRIAL REGISTRATION\nidentifier: NL34509.000.10 and trialregister.nl identifier: NTR3103. Show less
The time-course of the neuromuscular blocking effect of rocuronium depends on circulatory mixing and the rate of distribution into the interstitial space. In order to quantitatively evaluate these... Show moreThe time-course of the neuromuscular blocking effect of rocuronium depends on circulatory mixing and the rate of distribution into the interstitial space. In order to quantitatively evaluate these processes, a physiologically meaningful model of distribution kinetics based on circulatory transport and interstitial diffusion, was fitted to rocuronium disposition data in 10 patients using a population approach. Information on cardiac output and circulatory mixing was obtained from the kinetics of indocyanine green (ICG), which was injected simultaneously with rocuronium. As a compromise between physiological reality and parameter identifiability, the organs of the systemic circulation were lumped into a heterogeneous subsystem, described by an axially distributed model of extravascular diffusion. Diffusion into the interstitial space determines the rate of rocuronium distribution in the body (diffusional time constant 89 min). The resulting whole body distribution kinetics depends both on cardiac output and on the apparent permeability surface area product (0.16 l/min). The analysis of the ICG data revealed that heterogeneity of blood transit time through the systemic circulation decreased and that cardiopulmonary volume increased, respectively, with cardiac output. The approach should be useful for studying the effect of disease states on distribution kinetics of drugs. Show less
The person-centred analysis and prevention approach has long dominated proposals to improve patient safety in healthcare. In this approach, the focus is on the individual responsible for making an... Show moreThe person-centred analysis and prevention approach has long dominated proposals to improve patient safety in healthcare. In this approach, the focus is on the individual responsible for making an error. An alternative is the systems-centred approach, in which attention is paid to the organizational factors that create precursors for individual errors. This approach assumes that since humans are fallible, systems must be designed to prevent humans from making errors or to be tolerant to those errors. The questions raised by this approach might, for example, include asking why an individual had specific gaps in their knowledge, experience, or ability. The systems approach focuses on working conditions rather than on errors of individuals, as the likelihood of specific errors increases with unfavourable conditions. Since the factors that promote errors are not directly visible in the working environment, they are described as latent risk factors (LRFs). Safety failures in anaesthesia, in particular, and medicine, in general, result from multiple unfavourable LRFs, so we propose that effective interventions require that attention is paid to interactions between multiple factors and actors. Understanding how LRFs affect safety can enable us to design more effective control measures that will impact significantly on both individual performance and patient outcomes. Show less
Reekers, M.; Simon, M.J.G.; Boer, F.; Mooren, R.A.G.; Kleef, J.W. van; Dahan, A.; Vuyk, J. 2010
BACKGROUND: Indocyanine green plasma disappearance rate (ICG-PDR) is used to evaluate hepatic function. Although hepatic failure is generally said to occur with an ICG-PDR <18%/min, ICG... Show moreBACKGROUND: Indocyanine green plasma disappearance rate (ICG-PDR) is used to evaluate hepatic function. Although hepatic failure is generally said to occur with an ICG-PDR <18%/min, ICG disappearance rate is poorly defined in the healthy population, and a clear cutoff value of ICG-PDR that discriminates between normal hepatic function and hepatic failure has not yet been described. We therefore defined the ICG disappearance rate in an otherwise healthy patient population. In addition, we evaluated the noninvasive measurement of ICG-PDR (transcutaneously by pulse dye densitometry [PDD] at the finger and the nose) and compared these with the simultaneously performed invasive measurements of ICG-PDR (in arterial blood). METHODS: In patients without signs of liver disease, scheduled for elective nonhepatic surgery, 10 mg ICG was administered IV and ICG-PDR measured by PDD (DDG-2001, Nihon Kohden, Tokyo, Japan). In a subset of patients, arterial blood samples were gathered to compare PDD with invasive ICG measurements. Methods were compared using Bland-Altman analysis. The results of our study and reported studies on discriminative use of ICG-PDR in assessing liver failure were used to construct receiver operating characteristic curves. RESULTS: Forty-one patients were studied: 33 using the finger probe and 8 using the nose probe. The mean So noninvasive ICG-PDR in this patient population is 23.1% +/- 7.9%/min (n = 41) with a range of 9.7% to 43.2%/min. Bias (+/-2 SD, limits of agreement) for ICG-PDR measured by PDD compared with those measured in arterial blood were 1.6%/min (-5.2% to 8.3%/min) for the finger probe and -6.0%/min (-15.5% to 3.4%/min) for the nose probe. CONCLUSION: ICG-PDR values in a population without liver failure ranged well below 18%/min, cited as the cutoff value for hepatic failure. This cutoff value needs reconsideration. In addition, we conclude that the ICG concentration is adequately determined noninvasively by PDD. (Anesth Analg 2010;110:466-72) Show less
