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

When are bereaved family members approached for consent to organ donation: Commentary from 10 European member states

Background - To scope the timing of the approach to bereaved family members and request for organ donation in DBD and DCD potential donors, in 10 European member states. Are there changes in established practice regarding when family members are asked to consider organ donation? Methods – Representatives from 10 member states responded to a survey seeking information about: how death is diagnosed in the DBD and DCD potential donor; the legal consent system and law on organ donation; the existence of national or local protocols specifying when to approach relatives; and practices around the first moment of discussing organ donation and the formal request. Results – Findings suggest that the historic practice of decoupling the confirmation of death discussion and the request for organ donation in the potential DBD situation is becoming more ‘flexible’ or is changing to one in which a discussion about the potential of organ donation is taking place before confirmation of death. Conclusions – Decisions about the moment of asking may benefit from being embedded within local practices of ‘end of life’ care. Establishing donation as a usual part of end of life care would mean that the moment of asking would become a step in the dying trajectory, facilitating the fulfilment of wishes regarding post-death use of organs for transplantation

Interspinous process device versus standard conventional surgical decompression for lumbar spinal stenosis: Randomized controlled trial

Abstract Objective To assess whether interspinous process device implantation is more effective in the short term than conventional surgical decompression for patients with intermittent neurogenic claudication due to lumbar spinal stenosis. Design Randomized controlled trial. Setting Five neurosurgical centers (including one academic and four secondary level care centers) in the Netherlands. Participants 203 participants were referred to the Leiden-The Hague Spine Prognostic Study Group between October 2008 and September 2011; 159 participants with intermittent neurogenic claudication due to lumbar spinal stenosis at one or two levels with an indication for surgery were randomized. Interventions 80 participants received an interspinous process device and 79 participants underwent spinal bony decompression. Main outcome measures The primary outcome at short term (eight weeks) and long term (one year) follow-up was the Zurich Claudication Questionnaire score. Repeated measurements were made to compare outcomes over time. Results At eight weeks, the success rate according to the Zurich Claudication Questionnaire for the interspinous process device group (63%, 95% confidence interval 51% to 73%) was not superior to that for

Towards an Integrated Agriculture

Economics; Environmen

Post mortem tissue donation in the Netherlands: a nationwide approach

In this article we describe the organization of post mortem tissue donation in the Netherlands, the average number of tissue donors procured during the years 2015–2019 and the main challenges we face to improve this number. Licensed by the Dutch Ministry of Health, the Dutch Transplant Foundation (NTS) plays a central role in the organization of tissue donation. The NTS works closely with the Dutch hospitals, two tissue banks and a procurement organization. Potential tissue donors are reported to the NTS 24/7. After consulting the Donor Register and relatives give consent for donation, donors are subject to a thorough medical evaluation. If no medical contraindication is mentioned, the donor is approved for tissue donation. Each year, tissues of an average of 1918 donors (112.1 donors Per Million Population) are procured. After procurement of tissues, donor blood and tissues are tested on virology and quality respectively. Based on the test results and the assessment of potential disease transmission, tissues can either be released for transplantation or discarded. In conclusion, the Netherlands has developed a uniform, nationwide approach for safe and efficient post mortem tissue donation in which the NTS plays a central role. In the past 5 years, tissues from a considerable number of donors are procured. The NTS will continue to work together with their partners, by stimulating donor recognition, registration of the donor will, relatives’ informed consent and by extending donor selection criteria, for an even more efficient way to help patients on the waiting list for a transplantation. </p

Apprentissage de la langue et comparatisme culturel en Hollande : le métier de maître de langue (XVIIe-XIXe siècle)

Aux Pays-Bas, l’enseignement du français a connu une institutionnalisation tardive avec la loi de 1863  pour le secondaire et celle de 1876 pour le supérieur. Mais dans les Provinces-Unies il y a une longue tradition du métier de maître de langues. Du XVIIe au XIXe siècles, les maîtres, souvent plurilingues, ont réfléchi sur l’exercice de leur métier et ont produit des méthodes et autres ouvrages didactiques (Pielat, Mauger, du Casquet, Baudet, etc.). Le maître qui malgré les manuels est irremplaçable, doit être conscient des besoins de ses élèves ; il s’interroge sur la qualité et l’efficacité de son enseignement. Par son enseignement de langue, il transmet un grand nombre de savoirs à l’élève et fonctionne finalement comme un médiateur social, éducatif et culturel. Tentant de joindre l’utile à l’agréable pour le profit des élèves, il leur fait découvrir la langue et la culture étrangères mais aussi leur propre monde. En ce sens il est un acteur de la formation identitaire de ses apprenants.It was only in 1863 that French became part of the curriculum at Dutch secondary schools and in 1876 it received full status as a subject taught at university. However in Holland the teaching of French as a foreign language has a much longer tradition. From the seventeenth century onwards language teachers, often multi-lingual themselves, reflected on the practicalities of their speciality and produced a vast number of textbooks and other educational works (Pielat, Mauger, Du Casquet, Baudet etc.). The teacher, who in spite of his books remains essential, should be conscious of his pupils’ needs, make sure of the quality of his teaching and achieve the desired results. Through his work as a teacher he confers to his pupil a vast amount of knowledge in many fields, so that in fact he also acts as a social, educational and cultural intermediary. In an effort to combine the useful and the pleasurable he enables his pupils not only to find out about a foreign language and its culture, but also their own world. Thus his action helps to shape the identity of those he teaches

Molecular Cloud Structure in the Magellanic Clouds: Effect of Metallicity

The chemical structure of neutral clouds in low metallicity environments is examined with particular emphasis on the H to H_2 and C+ to CO transitions. We observed near-IR H_2 lines and the CO J=1-0 line from 30 Doradus and N159/N160 in the Large Magellanic Cloud and from DEM S 16, DEM S 37, and LI-SMC 36 in the Small Magellanic Cloud. We find that the H_2 emission is UV-excited and that (weak) CO emission always exists (in our surveyed regions) toward positions where H_2 and [CII] emission have been detected. Using a PDR code and a radiative transfer code, we simulate the emission of line radiation from spherical clouds and from large planar clouds. Because the [CII] emission and H_2 emission arise on the surface of the cloud and the lines are optically thin, these lines are not affected by changes in the relative sizes of the neutral cloud and the CO bearing core, while the optically thick CO emission can be strongly affected. The sizes of clouds are estimated by measuring the deviation of CO emission strength from that predicted by a planar cloud model of a given size. The average cloud column density and therefore size increases as the metallicity decreases. Our result agrees with the photoionization regulated star formation theory by Mc Kee (1989).Comment: 45 Pages including 15 figures. To be published in the ApJ May 10, 1998 issue, Vol. 49