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
Hassani, R.T.J.; Sandali, O.; Ouadfel, A.; Packer, M.; Romano, F.; Thuret, G.; ... ; Baudouin, C. 2020
Phacoemulsification is the most frequently performed surgery in the world. Over the past few years, this surgery seems to have reached a plateau with no further innovative breakthroughs. In this... Show morePhacoemulsification is the most frequently performed surgery in the world. Over the past few years, this surgery seems to have reached a plateau with no further innovative breakthroughs. In this paper, we focus on alternatives techniques, the latest innovations, and the research and development pipeline in this field. (C) 2020 Elsevier Masson SAS. All rights reserved. Show less
Durez, P.; Hoekema, A.; Huizinga, T.; Gazin, M.; Present, E.; Veelaert, D.; ... ; Westhovens, R. 2020
A better understanding of disease pathology, improvements in relevant disease outcomes, better treatment strategies and the development of novel therapies all contribute to improving healthcare and... Show moreA better understanding of disease pathology, improvements in relevant disease outcomes, better treatment strategies and the development of novel therapies all contribute to improving healthcare and treatment options. However, the global drug development model today is under increasing pressure, with very high drug development costs. Collaborative research is critical for bringing together different capabilities and expertise to increase the success of drug development, and large-scale collaborations with multiple partners are becoming increasingly common. Research clusters supported by local governments play an important role in bringing together academic centres, hospitals, scientists, and pharmaceutical and biotechnology industries. The 'triple helix' model, with academia, industry and governments working together, has been an important factor in the successful development of novel therapies. During the past 20 years, Galapagos has worked closely with academic centres, hospitals, governments and pharmaceutical companies to conduct innovative research and to develop a novel therapy for rheumatoid arthritis. These collaborations have brought unique knowledge, expertise and skills together, as well as crucial funding at various stages. Local governments in the Benelux have operated in this triple helix model to provide the necessary environment and to stimulate companies to achieve innovation through collaboration. Although the triple helix has already proved successful, evolution to a quadruple helix that includes patients and patient representatives could be the next step to ensure innovation remains transformational. Show less
Background The Idea, Development, Exploration, Assessment and Long-term study (IDEAL) framework was created to provide a structured way for assessing and evaluating novel surgical techniques and... Show moreBackground The Idea, Development, Exploration, Assessment and Long-term study (IDEAL) framework was created to provide a structured way for assessing and evaluating novel surgical techniques and devices. Objectives The aim of this paper was to investigate the utilization of the IDEAL framework within neurosurgery, and to identify factors influencing implementation. Methods A bibliometric analysis of the 7 key IDEAL papers on Scopus, PubMed, Embase, Web of Science, and Google Scholar databases (2009-2019) was performed. A second journal-specific search then identified additional papers citing the IDEAL framework. Publications identified were screened by two independent reviewers to select neurosurgery-specific articles. Results The citation search identified 1336 articles. The journal search identified another 16 articles. Following deduplication and review, 51 relevant articles remained; 14 primary papers (27%) and 37 secondary papers (73%). Of the primary papers, 5 (36%) papers applied the IDEAL framework to their research correctly; two were aligned to the pre-IDEAL stage, one to the Idea and Development stages, and two to the Exploration stage. Of the secondary papers, 21 (57%) explicitly discussed the IDEAL framework. Eighteen (86%) of these were supportive of implementing the framework, while one was not, and two were neutral. Conclusion The adoption of the IDEAL framework in neurosurgery has been slow, particularly for early-stage neurosurgical techniques and inventions. However, the largely positive reviews in secondary literature suggest potential for increased use that may be achieved with education and publicity. Show less
Care for older persons is changing. A new primary health care concept is called ‘person-centred, integrated care’ involving changing roles for General Practitioners (GPs) and other... Show moreCare for older persons is changing. A new primary health care concept is called ‘person-centred, integrated care’ involving changing roles for General Practitioners (GPs) and other professionals. The inclusion of the personal values of the patients in the changing care is essential but vulnerable. This thesis links the process of innovating care and the values of the older persons involved, by studying patient satisfaction as an expression of personal value in two care innovation and implementation projects. Key findings are: The level of patient satisfaction is related to complexity of health problems and is related more to the care organization than to the condition of the patient. Modifiable communicative aspects of GP behavior are related to patient satisfaction. Patients and GPs, show different satisfaction about aspects of care reflecting different values. In a real-life implementation strategy, patient satisfaction and engagement is feasible and valuable. Conclusions are that patient satisfaction can be used in innovating care but must be interpreted with caution. Also older patients need a role in the implementation process in order to assure that their values are expressed in the care innovation. A combination of individual shared decision making, satisfaction investigation and procedural engagement is proposed. Show less
The current thesis explores the evidence base of new techniques in minimally invasive surgery. For this purpose the main objectives of this thesis are: • To present a multidisciplinary... Show moreThe current thesis explores the evidence base of new techniques in minimally invasive surgery. For this purpose the main objectives of this thesis are: • To present a multidisciplinary evidence based guideline for MIS including the main topics in laparoscopic surgery; • To identify the evidence of three new minimally invasive techniques: trocar types for laparoscopy, LESS-hysterectomy and hysteroscopic sterilization; • To evaluate the course of introduction of a new minimally invasive technique (robot-assisted surgery) and the status of the evidence; • To assess whether recent RCTs serve the clinical needs of the MIS approach. Providing the answers to these questions, this thesis provides insight in the evidence of MIS and its limitations. Therewith, it provides guidance to optimize research and evidence based implementation of MIS towards better minimally invasive surgical care. Show less
