Background Interprofessional education (IPE) aims to improve students’ collaborative competencies... more Background Interprofessional education (IPE) aims to improve students’ collaborative competencies and behaviour. The effect of classroom IPE on students’ perceptions of collaboration in clinical practice, and how knowledge is possibly transferred, has yet to be investigated. The research question of this study was: How does IPE in a classroom setting influence students’ perceptions of collaboration in clinical practice? Social capital theory is used as the theoretical lens. Social capital theory describes how social relationships generate benefits for the individuals involved. Social capital can be divided into three forms of social cohesion: bonding, bridging and linking social capital. Bonding refers to connections that are close and strong, such as family. Bridging social capital occurs in more distant relationships. Linking social capital refers to relationships between individuals with different power or social status. Methods A qualitative study with semi-structured face-to-fa...
Outcome of acquired brain injury (ABI) and the potential for neurorehabilitation are subject to d... more Outcome of acquired brain injury (ABI) and the potential for neurorehabilitation are subject to distinct heterogeneity between patients. Limited knowledge of the complex constellation of determinants at play interferes with the possibility to deploy precision medicine in neurorehabilitation. Measurement Feedback Systems (MFS) structure clinical data collection and deliver the measurement results as feedback to clinicians, thereby facilitating progress monitoring, promoting balanced patient-centered discussion and shared decision making. Accumulation of clinical data in the MFS also enables data-driven precision rehabilitation medicine. This article describes the development and implementation of a MFS for neurorehabilitation after ABI. The MFS consists of specialized measurement tracks which are developed together with representatives of each discipline in the multidisciplinary team. The MFS is built into a digital platform that automatically distributes measurements among clinician...
Background. Nowadays, medical education is mainly bio-medical oriented and societal themes are no... more Background. Nowadays, medical education is mainly bio-medical oriented and societal themes are not systematically integrated. However, medical education has an obligation to align education, research, and healthcare with societal needs. Education in social accountability equips students with the knowledge and skills to be a socially accountable health professional. This study aims to investigate the way educational staff and students in a medical school define social accountability.Methods. A qualitative study was conducted in which 28 educational staff members and 16 students at a medical school in the Netherlands were individually interviewed using a semi-structured interview script. The interviews were qualitatively analyzed according to the grounded theory method.Results. Social accountability is seen as a reciprocal, institutional, context-dependent, and multifactorial construct. The following aspects are distinguished: sustainability, interprofessional collaboration, person-ce...
Meningioma patients often have subtle cognitive deficits that might be attributed to the tumor it... more Meningioma patients often have subtle cognitive deficits that might be attributed to the tumor itself, to surgical treatment, or to the occurrence of seizures and their treatment. Magnetoencephalography (MEG) analysis of resting-state functional networks (RSNs) could help to understand the neurophysiological basis of cognitive impairment in these patients. We explored the correlation between RSN functional connectivity and topology of functional networks on the one hand, and cognition on the other hand in WHO grade I meningioma patients. Twenty adult WHO grade I meningioma patients who had undergone tumor resection, as well as 20 healthy matched controls, were included. Neuropsychological assessment was done through a standardized test battery. MEG data were recorded, and projected to the anatomical space of the Automated Anatomical Labeling atlas. Functional connectivity (PLI), within the default mode network (DMN) and the bilateral frontoparietal networks were correlated to cognit...
Academic medicine : journal of the Association of American Medical Colleges, Jan 26, 2016
Because unprofessional behavior of physicians is associated with unprofessional behavior in medic... more Because unprofessional behavior of physicians is associated with unprofessional behavior in medical school, identifying unprofessional behavior in medical school is critical. Research has noted the difficulty in assessing professional behavior. Instead of identifying isolated behaviors, it could be more helpful to recognize behavioral patterns to evaluate students' professional behavior. The authors aimed to identify patterns in the unprofessional behaviors of medical students and to construct descriptions based on these patterns. Content analysis of research articles yielded a template of unprofessional behaviors for coding student evaluation forms indicating unsatisfactory professional behavior, collected from 2012 to 2014 at the VUmc School of Medical Sciences, Amsterdam, the Netherlands. Latent class analysis was used to identify classes of students with a high chance of displaying comparable unprofessional behaviors. Teachers' feedback of prototype students was summariz...
Traumatic brain injury (TBI)-related coagulopathy appears to be most prevalent in patients with t... more Traumatic brain injury (TBI)-related coagulopathy appears to be most prevalent in patients with tissue hypoperfusion, but evidence for this association is scarce. This study investigated the relationship between tissue perfusion and hemostatic derangements in TBI patients. Coagulation parameters were measured on emergency department admission in patients with TBI (head abbreviated injury scale ≥ 3). The level of hypoperfusion was simultaneously assessed by near-infrared spectroscopy (NIRS) at the forehead and arm, and by base excess and lactate. Coagulopathy was defined as an international normalized ratio > 1.2 and/or activated partial thromboplastin time > 40 s and/or thrombocytopenia (<120 × 10(9)/L). TBI patients with coagulopathy (42%) had more signs of tissue hypoperfusion as indicated by increased lactate levels (2.1 [1.1-3.2] mmol/L versus 1.2 [1.0-1.7] mmol/L; P = 0.017) and a larger base deficit (-3.0 [-4.6 to -2.0] mmol/L versus -0.1 [-2.5 to 1.8] mmol/L; P < 0.001). There was no difference in the cerebral or somatic tissue oxygenation index. However, there was a distinct trend toward a moderate inverse association between the cerebral tissue oxygenation index and D-dimer levels (r=-0.40; P = 0.051) as marker of fibrinolysis. The presence of coagulopathy was associated with an increased inhospital mortality rate (45.5% versus 6.7%; P = 0.002). This is the first study to investigate the relationship between hemostatic derangements and tissue oxygenation using NIRS in TBI patients. This study showed that TBI-related coagulopathy is more profound in patients with metabolic acidosis and increased lactate levels. Although there was no direct relationship between tissue oxygenation and coagulopathy, we observed an inverse relationship between NIRS tissue oxygenation levels and fibrinolysis.
ABSTRACT Doel van dit onderzoek is een analyse van de complicaties bij kinderen met intrathecale ... more ABSTRACT Doel van dit onderzoek is een analyse van de complicaties bij kinderen met intrathecale baclofentherapie. Meer specifiek werd gekeken naar aard, frequentie, impact (d.m.v. verzorgertevredenheid) en mogelijke determinanten van het optreden van complicaties. Hiertoe werd retrospectief statusonderzoek uitgevoerd en een cross-sectionele tevredenheidsvragenlijst afgenomen. Alle kinderen (t/m 17 jaar) behandeld met intrathecale baclofentherapie in het VU medisch centrum zijn geanalyseerd. De minimale follow-up was zes maanden. Het betreft baclofenpompimplantaties tussen maart 2001 en mei 2007. Een complicatiefrequentie van 0,28 (0,19-0,42) complicaties per patiënt per jaar werd gevonden. In de literatuur bedraagt de complicatiefrequentie tussen de 0,09 en 0,58 complicaties per patiënt per jaar. Kathetergerelateerde complicaties kwamen het meest frequent voor. Drie gevonden determinanten voor het optreden van complicaties zijn: kathetertiphoogte, pulmonale comorbiditeit en corticosteroïdengebruik. Het tevredenheidsonderzoek wees uit dat ouders/verzorgers van kinderen met één of meer complicaties niet minder tevreden waren dan ouders van kinderen zonder complicaties. Van de ondervraagden zou 88% de keuze voor intrathecale baclofentherapie nog steeds maken. De resultaten van het tevredenheidsonderzoek bevestigen de hypothese dat ouders/verzorgers in hun oordeel de functionele waarde van de behandeling zwaarder laten wegen dan de eventuele complicaties. Aim of this research is an analysis of the complications in children with intrathecal baclofen therapy. More specific by analysing nature, frequency, impact (by means of caregiver satisfaction) and possible determinants of complications. For that purpose retrospective data research was conducted and a cross-sectional satisfaction questionnaire was administered. All children treated with intrathecal baclofen therapy in the VU medical centre, Amsterdam, are included in the study. Minimum follow-up was six months. The baclofen pumps were implanted from March 2001 to May 2007.We found 0.28 (0.19-0.42) complications per patient per year. In other studies this value varies between 0.09 and 0.58 complications per patient per year. Catheter-related complications were the most common. Three determinants proved to be associated with the rate of complications: the level of the catheter tip, pulmonary co-morbidity and the use of corticosteroids. The results of the satisfaction questionnaire showed that there is no less satisfaction in parents/guardians of children with one or more complications as compared to parents of children without complications. Of parents questioned, 88% would again choose for intrathecal baclofen therapy. The results of the satisfaction questionnaire support the hypothesis that in their judgement parents/guardians focus more on functional gain of the treatment than on possible complications.
Chronic subdural haematoma (csdh) is difficult to diagnose because patients with this disorder, i... more Chronic subdural haematoma (csdh) is difficult to diagnose because patients with this disorder, in particular the elderly, present with such a wide variety of symptoms. The subject of this case study is an 89-year-old man with a history of csdh who presented with severe depressive symptoms with psychotic features and who in the end turned out to have a recurrence of csdh. An integrated past and who present with psychiatric problems and fall frequently. When a patient presents with such symptoms, one needs to be on the look-out for a recurrence of csdh.
Training of doctors in The Netherlands seeks to develop clinical competences including profession... more Training of doctors in The Netherlands seeks to develop clinical competences including professional behaviour. Behaving as a professional is not just a desirable trait but a clearly stated requirement for doctors and medical students. We designed an educational theme, Professional Behaviour (PB), as a longitudinal thread throughout our six-year curriculum after defining PB as "The observable aspects of practising professionalism". This definition was translated into a set of practical skills that can be observed: "The ability to deal with tasks, to deal with others and to deal with oneself". We assess PB 29 times in the course of the medical curriculum. Students with an unsatisfactory PB do not get their degree irrespective of their medical knowledge. We train teachers to identify and report unprofessional student behaviour, and we offer these students interventions and support. With the educational theme "Professional Behaviour" we have defined PB for our institute and firmly embedded it in the medical curriculum. We use workplace learning and role models for teaching PB. Different teachers carry out multiple formative and summative assessments, using standardized assessment scales. With these measures we intend to promote a culture of excellence in PB in our institute.
Background Interprofessional education (IPE) aims to improve students’ collaborative competencies... more Background Interprofessional education (IPE) aims to improve students’ collaborative competencies and behaviour. The effect of classroom IPE on students’ perceptions of collaboration in clinical practice, and how knowledge is possibly transferred, has yet to be investigated. The research question of this study was: How does IPE in a classroom setting influence students’ perceptions of collaboration in clinical practice? Social capital theory is used as the theoretical lens. Social capital theory describes how social relationships generate benefits for the individuals involved. Social capital can be divided into three forms of social cohesion: bonding, bridging and linking social capital. Bonding refers to connections that are close and strong, such as family. Bridging social capital occurs in more distant relationships. Linking social capital refers to relationships between individuals with different power or social status. Methods A qualitative study with semi-structured face-to-fa...
Outcome of acquired brain injury (ABI) and the potential for neurorehabilitation are subject to d... more Outcome of acquired brain injury (ABI) and the potential for neurorehabilitation are subject to distinct heterogeneity between patients. Limited knowledge of the complex constellation of determinants at play interferes with the possibility to deploy precision medicine in neurorehabilitation. Measurement Feedback Systems (MFS) structure clinical data collection and deliver the measurement results as feedback to clinicians, thereby facilitating progress monitoring, promoting balanced patient-centered discussion and shared decision making. Accumulation of clinical data in the MFS also enables data-driven precision rehabilitation medicine. This article describes the development and implementation of a MFS for neurorehabilitation after ABI. The MFS consists of specialized measurement tracks which are developed together with representatives of each discipline in the multidisciplinary team. The MFS is built into a digital platform that automatically distributes measurements among clinician...
Background. Nowadays, medical education is mainly bio-medical oriented and societal themes are no... more Background. Nowadays, medical education is mainly bio-medical oriented and societal themes are not systematically integrated. However, medical education has an obligation to align education, research, and healthcare with societal needs. Education in social accountability equips students with the knowledge and skills to be a socially accountable health professional. This study aims to investigate the way educational staff and students in a medical school define social accountability.Methods. A qualitative study was conducted in which 28 educational staff members and 16 students at a medical school in the Netherlands were individually interviewed using a semi-structured interview script. The interviews were qualitatively analyzed according to the grounded theory method.Results. Social accountability is seen as a reciprocal, institutional, context-dependent, and multifactorial construct. The following aspects are distinguished: sustainability, interprofessional collaboration, person-ce...
Meningioma patients often have subtle cognitive deficits that might be attributed to the tumor it... more Meningioma patients often have subtle cognitive deficits that might be attributed to the tumor itself, to surgical treatment, or to the occurrence of seizures and their treatment. Magnetoencephalography (MEG) analysis of resting-state functional networks (RSNs) could help to understand the neurophysiological basis of cognitive impairment in these patients. We explored the correlation between RSN functional connectivity and topology of functional networks on the one hand, and cognition on the other hand in WHO grade I meningioma patients. Twenty adult WHO grade I meningioma patients who had undergone tumor resection, as well as 20 healthy matched controls, were included. Neuropsychological assessment was done through a standardized test battery. MEG data were recorded, and projected to the anatomical space of the Automated Anatomical Labeling atlas. Functional connectivity (PLI), within the default mode network (DMN) and the bilateral frontoparietal networks were correlated to cognit...
Academic medicine : journal of the Association of American Medical Colleges, Jan 26, 2016
Because unprofessional behavior of physicians is associated with unprofessional behavior in medic... more Because unprofessional behavior of physicians is associated with unprofessional behavior in medical school, identifying unprofessional behavior in medical school is critical. Research has noted the difficulty in assessing professional behavior. Instead of identifying isolated behaviors, it could be more helpful to recognize behavioral patterns to evaluate students' professional behavior. The authors aimed to identify patterns in the unprofessional behaviors of medical students and to construct descriptions based on these patterns. Content analysis of research articles yielded a template of unprofessional behaviors for coding student evaluation forms indicating unsatisfactory professional behavior, collected from 2012 to 2014 at the VUmc School of Medical Sciences, Amsterdam, the Netherlands. Latent class analysis was used to identify classes of students with a high chance of displaying comparable unprofessional behaviors. Teachers' feedback of prototype students was summariz...
Traumatic brain injury (TBI)-related coagulopathy appears to be most prevalent in patients with t... more Traumatic brain injury (TBI)-related coagulopathy appears to be most prevalent in patients with tissue hypoperfusion, but evidence for this association is scarce. This study investigated the relationship between tissue perfusion and hemostatic derangements in TBI patients. Coagulation parameters were measured on emergency department admission in patients with TBI (head abbreviated injury scale ≥ 3). The level of hypoperfusion was simultaneously assessed by near-infrared spectroscopy (NIRS) at the forehead and arm, and by base excess and lactate. Coagulopathy was defined as an international normalized ratio > 1.2 and/or activated partial thromboplastin time > 40 s and/or thrombocytopenia (<120 × 10(9)/L). TBI patients with coagulopathy (42%) had more signs of tissue hypoperfusion as indicated by increased lactate levels (2.1 [1.1-3.2] mmol/L versus 1.2 [1.0-1.7] mmol/L; P = 0.017) and a larger base deficit (-3.0 [-4.6 to -2.0] mmol/L versus -0.1 [-2.5 to 1.8] mmol/L; P < 0.001). There was no difference in the cerebral or somatic tissue oxygenation index. However, there was a distinct trend toward a moderate inverse association between the cerebral tissue oxygenation index and D-dimer levels (r=-0.40; P = 0.051) as marker of fibrinolysis. The presence of coagulopathy was associated with an increased inhospital mortality rate (45.5% versus 6.7%; P = 0.002). This is the first study to investigate the relationship between hemostatic derangements and tissue oxygenation using NIRS in TBI patients. This study showed that TBI-related coagulopathy is more profound in patients with metabolic acidosis and increased lactate levels. Although there was no direct relationship between tissue oxygenation and coagulopathy, we observed an inverse relationship between NIRS tissue oxygenation levels and fibrinolysis.
ABSTRACT Doel van dit onderzoek is een analyse van de complicaties bij kinderen met intrathecale ... more ABSTRACT Doel van dit onderzoek is een analyse van de complicaties bij kinderen met intrathecale baclofentherapie. Meer specifiek werd gekeken naar aard, frequentie, impact (d.m.v. verzorgertevredenheid) en mogelijke determinanten van het optreden van complicaties. Hiertoe werd retrospectief statusonderzoek uitgevoerd en een cross-sectionele tevredenheidsvragenlijst afgenomen. Alle kinderen (t/m 17 jaar) behandeld met intrathecale baclofentherapie in het VU medisch centrum zijn geanalyseerd. De minimale follow-up was zes maanden. Het betreft baclofenpompimplantaties tussen maart 2001 en mei 2007. Een complicatiefrequentie van 0,28 (0,19-0,42) complicaties per patiënt per jaar werd gevonden. In de literatuur bedraagt de complicatiefrequentie tussen de 0,09 en 0,58 complicaties per patiënt per jaar. Kathetergerelateerde complicaties kwamen het meest frequent voor. Drie gevonden determinanten voor het optreden van complicaties zijn: kathetertiphoogte, pulmonale comorbiditeit en corticosteroïdengebruik. Het tevredenheidsonderzoek wees uit dat ouders/verzorgers van kinderen met één of meer complicaties niet minder tevreden waren dan ouders van kinderen zonder complicaties. Van de ondervraagden zou 88% de keuze voor intrathecale baclofentherapie nog steeds maken. De resultaten van het tevredenheidsonderzoek bevestigen de hypothese dat ouders/verzorgers in hun oordeel de functionele waarde van de behandeling zwaarder laten wegen dan de eventuele complicaties. Aim of this research is an analysis of the complications in children with intrathecal baclofen therapy. More specific by analysing nature, frequency, impact (by means of caregiver satisfaction) and possible determinants of complications. For that purpose retrospective data research was conducted and a cross-sectional satisfaction questionnaire was administered. All children treated with intrathecal baclofen therapy in the VU medical centre, Amsterdam, are included in the study. Minimum follow-up was six months. The baclofen pumps were implanted from March 2001 to May 2007.We found 0.28 (0.19-0.42) complications per patient per year. In other studies this value varies between 0.09 and 0.58 complications per patient per year. Catheter-related complications were the most common. Three determinants proved to be associated with the rate of complications: the level of the catheter tip, pulmonary co-morbidity and the use of corticosteroids. The results of the satisfaction questionnaire showed that there is no less satisfaction in parents/guardians of children with one or more complications as compared to parents of children without complications. Of parents questioned, 88% would again choose for intrathecal baclofen therapy. The results of the satisfaction questionnaire support the hypothesis that in their judgement parents/guardians focus more on functional gain of the treatment than on possible complications.
Chronic subdural haematoma (csdh) is difficult to diagnose because patients with this disorder, i... more Chronic subdural haematoma (csdh) is difficult to diagnose because patients with this disorder, in particular the elderly, present with such a wide variety of symptoms. The subject of this case study is an 89-year-old man with a history of csdh who presented with severe depressive symptoms with psychotic features and who in the end turned out to have a recurrence of csdh. An integrated past and who present with psychiatric problems and fall frequently. When a patient presents with such symptoms, one needs to be on the look-out for a recurrence of csdh.
Training of doctors in The Netherlands seeks to develop clinical competences including profession... more Training of doctors in The Netherlands seeks to develop clinical competences including professional behaviour. Behaving as a professional is not just a desirable trait but a clearly stated requirement for doctors and medical students. We designed an educational theme, Professional Behaviour (PB), as a longitudinal thread throughout our six-year curriculum after defining PB as "The observable aspects of practising professionalism". This definition was translated into a set of practical skills that can be observed: "The ability to deal with tasks, to deal with others and to deal with oneself". We assess PB 29 times in the course of the medical curriculum. Students with an unsatisfactory PB do not get their degree irrespective of their medical knowledge. We train teachers to identify and report unprofessional student behaviour, and we offer these students interventions and support. With the educational theme "Professional Behaviour" we have defined PB for our institute and firmly embedded it in the medical curriculum. We use workplace learning and role models for teaching PB. Different teachers carry out multiple formative and summative assessments, using standardized assessment scales. With these measures we intend to promote a culture of excellence in PB in our institute.
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