Met het oog op wachttijd

Zonder een goed functionerend hoornvlies, hierna genoemd cornea, kunnen de ogen hun taak niet goed uitvoeren. Iets meer dan 100 jaar geleden, in 1905, werd de eerstes uccesvolle transplantatie van een cornea van een overleden donor uitgevoerd in Tsjechië, door oogarts Zirm. Mede door de ontwikkeling van operatiemicroscopen, extra dun hechtdraad en het gebruik van antibiotica worden vandaag de dag in Nederland ongeveer 900 corneatransplantaties per jaar uitgevoerd. In Nederland is de Nederlandse transplantatie Stichting (NTS) verantwoordelijk voor het toewijzen van cornea’s aan patiënten (Bokhorst et al., 2007).\ud De gemiddelde wachttijd voor een cornea in Nederland is ongeveer een half jaar, ofwel 175 dagen. (Zie figuur 1) De door de NTS en oogartsen meest genoemde oorzaken zijn een tekort aan operatiecapaciteit en cornea’s en de fluctuatie in zowel vraag als aanbod van cornea’s. Ons eerste doel was te onderzoeken in welke mate deze zaken de wachttijd beïnvloeden. Een tweede doel was mogelijke verbeteringen aan te dragen

Imminent brain death: point of departure for potential heart-beating organ donor recognition

Contains fulltext : 88186.pdf (publisher's version ) (Closed access)PURPOSE: There is, in European countries that conduct medical chart review of intensive care unit (ICU) deaths, no consensus on uniform criteria for defining a potential organ donor. Although the term is increasingly being used in recent literature, it is seldom defined in detail. We searched for criteria for determination of imminent brain death, which can be seen as a precursor for organ donation. METHODS: We organized meetings with representatives from the field of clinical neurology, neurotraumatology, intensive care medicine, transplantation medicine, clinical intensive care ethics, and organ procurement management. During these meetings, all possible criteria were discussed to identify a patient with a reasonable probability to become brain dead (imminent brain death). We focused on the practical usefulness of two validated coma scales (Glasgow Coma Scale and the FOUR Score), brain stem reflexes and respiration to define imminent brain death. Further we discussed criteria to determine irreversibility and futility in acute neurological conditions. RESULTS: A patient who fulfills the definition of imminent brain death is a mechanically ventilated deeply comatose patient, admitted to an ICU, with irreversible catastrophic brain damage of known origin. A condition of imminent brain death requires either a Glasgow Coma Score of 3 and the progressive absence of at least three out of six brain stem reflexes or a FOUR score of E(0)M(0)B(0)R(0). CONCLUSION: The definition of imminent brain death can be used as a point of departure for potential heart-beating organ donor recognition on the intensive care unit or retrospective medical chart analysis.1 september 201

Photography or Ophthalmoscopy for Detection of Diabetic Retinopathy?

The U.K. National Screening Committee recommended digital fundus photography as the screening method of choice for diabetic retinopathy (DR). However, concerns have been expressed about replacing ophthalmoscopy with slit-lamp biomicroscopy by digital photography. These concerns included the possibility of missing peripheral and stereoscopic visible retinal lesions; increased chance of a technical failure compared with ophthalmoscopy, resulting in more reexaminations; and higher cost (1). New data from our study of 453 patients with diabetes, aged 31–86 years, highlight the need for a careful consideration of the retinal area photographed and the minimal resolution of images to detect DR