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Article ; Online: Bridging the gap between clinical pharmacology and rational drug prescribing 2.0: An up-date after 30 years.

Donker, Erik M / Bakkum, Michiel J / Richir, Milan C / Tichelaar, Jelle

British journal of clinical pharmacology

2024

Language	English
Publishing date	2024-03-14
Publishing country	England
Document type	Journal Article
ZDB-ID	188974-6
ISSN	1365-2125 ; 0306-5251 ; 0264-3774
ISSN (online)	1365-2125
ISSN	0306-5251 ; 0264-3774
DOI	10.1111/bcp.16051
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Article: Diagnostic pitfalls after COVID-19 vaccination in melanoma and breast cancer patients: A case series.

de Bock, Ellen / Trumpi, Kari / Suijkerbuijk, Karijn P M / Vriens, Menno R / Richir, Milan C

International journal of surgery case reports

2022 Volume 93, Page(s) 106938

Abstract: Introduction: During the current Coronavirus Disease 2019 (COVID-19) pandemic, significant COVID-19 disease-reducing developments have been made, culminating in the COVID-19 vaccines. However, COVID-19 vaccines may complicate oncological staging and ... ...

Abstract	Introduction: During the current Coronavirus Disease 2019 (COVID-19) pandemic, significant COVID-19 disease-reducing developments have been made, culminating in the COVID-19 vaccines. However, COVID-19 vaccines may complicate oncological staging and follow-up oncological disease course since they may induce the enlargement of lymph nodes. Consequently, this uncertainty may lead to increased distress. Presentation of cases: This case series describes seven patients diagnosed with melanoma or breast cancer in whom lymphadenopathy was observed on oncology imaging after COVID-19 vaccination. Four of these patients underwent additional diagnostic testing, all without malignant cells on pathological examination or suspected metastasis on imaging. The remaining patients were re-evaluated, and the lymphadenopathy was interpreted as an adverse outcome of the recent COVID-19 vaccination. In addition, four out of seven patients were vaccinated in the ipsilateral arm relative to the tumor. Abnormal lymph nodes could be observed up to sixty-nine days after COVID-19 vaccination. Discussion and conclusion: These findings indicate that a COVID-19 vaccination may result in possible false-positive oncological imaging findings in melanoma and breast cancer patients. Moreover, it is advised to administer the vaccine in the contralateral arm of the primary tumor, suspected breast abnormalities, or after the oncologic imaging in melanoma and breast cancer patients.
Language	English
Publishing date	2022-03-12
Publishing country	Netherlands
Document type	Journal Article
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2022.106938
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Article ; Online: Sustainable medicines use in clinical practice-It is time to help the teacher.

Bakkum, Michiel J / Richir, Milan C / van Agtmael, Michiel A / Tichelaar, Jelle

British journal of clinical pharmacology

2022 Volume 88, Issue 7, Page(s) 3030–3031

Language	English
Publishing date	2022-04-05
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	188974-6
ISSN	1365-2125 ; 0306-5251 ; 0264-3774
ISSN (online)	1365-2125
ISSN	0306-5251 ; 0264-3774
DOI	10.1111/bcp.15340
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Using artificial intelligence to create diverse and inclusive medical case vignettes for education.

Bakkum, Michiel J / Hartjes, Mariëlle G / Piët, Joost D / Donker, Erik M / Likic, Robert / Sanz, Emilio / de Ponti, Fabrizio / Verdonk, Petra / Richir, Milan C / van Agtmael, Michiel A / Tichelaar, Jelle

British journal of clinical pharmacology

2024 Volume 90, Issue 3, Page(s) 640–648

Abstract: Aims: Medical case vignettes play a crucial role in medical education, yet they often fail to authentically represent diverse patients. Moreover, these vignettes tend to oversimplify the complex relationship between patient characteristics and medical ... ...

Abstract	Aims: Medical case vignettes play a crucial role in medical education, yet they often fail to authentically represent diverse patients. Moreover, these vignettes tend to oversimplify the complex relationship between patient characteristics and medical conditions, leading to biased and potentially harmful perspectives among students. Displaying aspects of patient diversity, such as ethnicity, in written cases proves challenging. Additionally, creating these cases places a significant burden on teachers in terms of labour and time. Our objective is to explore the potential of artificial intelligence (AI)-assisted computer-generated clinical cases to expedite case creation and enhance diversity, along with AI-generated patient photographs for more lifelike portrayal. Methods: In this study, we employed ChatGPT (OpenAI, GPT 3.5) to develop diverse and inclusive medical case vignettes. We evaluated various approaches and identified a set of eight consecutive prompts that can be readily customized to accommodate local contexts and specific assignments. To enhance visual representation, we utilized Adobe Firefly beta for image generation. Results: Using the described prompts, we consistently generated cases for various assignments, producing sets of 30 cases at a time. We ensured the inclusion of mandatory checks and formatting, completing the process within approximately 60 min per set. Conclusions: Our approach significantly accelerated case creation and improved diversity, although prioritizing maximum diversity compromised representativeness to some extent. While the optimized prompts are easily reusable, the process itself demands computer skills not all educators possess. To address this, we aim to share all created patients as open educational resources, empowering educators to create cases independently.
MeSH term(s)	Humans ; Artificial Intelligence ; Education, Medical ; Ethnicity
Language	English
Publishing date	2024-01-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	188974-6
ISSN	1365-2125 ; 0306-5251 ; 0264-3774
ISSN (online)	1365-2125
ISSN	0306-5251 ; 0264-3774
DOI	10.1111/bcp.15977
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Article ; Online: Medical students as junior adverse drug event managers facilitating reporting of ADRs.

Reumerman, Michael O / Tichelaar, Jelle / Richir, Milan C / van Agtmael, Michiel A

British journal of clinical pharmacology

2021 Volume 87, Issue 12, Page(s) 4853–4860

Abstract: The Junior Adverse Drug Event Manager (J-ADEM) team is a multifaceted intervention focusing on real-life education for medical students that has been shown to assist healthcare professionals in managing and reporting suspected adverse drug reactions ( ... ...

Abstract	The Junior Adverse Drug Event Manager (J-ADEM) team is a multifaceted intervention focusing on real-life education for medical students that has been shown to assist healthcare professionals in managing and reporting suspected adverse drug reactions (ADRs) to the Netherlands Pharmacovigilance Centre Lareb. The aim of this study was to quantify and describe the ADRs reported by the J-ADEM team and to determine the clinical potential of this approach. The J-ADEM team consisted of medical students tasked with managing and reporting ADRs in hospitalized patients. All ADRs screened and reported by J-ADEM team were recorded anonymously, and categorized and analysed descriptively. From August 2018 through January 2020, 209 patients on two wards in an academic hospital were screened for ADR events. The J-ADEM team reported 101 ADRs. Although most ADRs (67%) were first identified by healthcare professionals and then reported by the J-ADEM team, the team also reported an additional 33 not previously identified serious ADRs. In 10% of all reported ADRs, the J-ADEM team helped optimize ADR treatment. The ADR reports were largely well-documented (78%), and ADRs were classified as type A (66%), had a moderate or severe severity (85%) and were predominantly avoidable reactions (69%). This study shows that medical students are able to screen patients for ADRs, can identify previously undetected ADRs and can help optimize ADR management. They significantly increased (by 300%) the number of ADR reports submitted, showing that the J-ADEM team can make a valuable clinical contribution to hospital care.
MeSH term(s)	Adverse Drug Reaction Reporting Systems ; Drug-Related Side Effects and Adverse Reactions/diagnosis ; Drug-Related Side Effects and Adverse Reactions/epidemiology ; Humans ; Patients ; Pharmacovigilance ; Students, Medical
Language	English
Publishing date	2021-05-26
Publishing country	England
Document type	Journal Article
ZDB-ID	188974-6
ISSN	1365-2125 ; 0306-5251 ; 0264-3774
ISSN (online)	1365-2125
ISSN	0306-5251 ; 0264-3774
DOI	10.1111/bcp.14885
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 1118: Show issues

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Article ; Online: Meta-analysis of COVID-19 prevalence during preoperative COVID-19 screening in asymptomatic patients.

de Bock, Ellen / Filipe, Mando D / Simmermacher, Roger K J / Kroese, A Christiaan / Vriens, Menno R / Richir, Milan C

BMJ open

2022 Volume 12, Issue 7, Page(s) e058389

Abstract: Objectives: Patients with COVID-19 may be asymptomatic and are able to transmit COVID-19 during a surgical procedure, resulting in increased pressure on healthcare and reduced control of COVID-19 spread. There remains uncertainty about the ... ...

Abstract	Objectives: Patients with COVID-19 may be asymptomatic and are able to transmit COVID-19 during a surgical procedure, resulting in increased pressure on healthcare and reduced control of COVID-19 spread. There remains uncertainty about the implementation of preoperative screening for COVID-19 in asymptomatic surgical patients. Therefore, this study aims to determine the prevalence of preoperative COVID-19, confirmed by reverse transcriptase PCR (RT-PCR), in asymptomatic patients. Design: Systematic review and meta-analysis. Data sources: Pubmed and Embase databases were searched through 20 February 2022. Eligibility criteria: All COVID-19 articles including preoperative asymptomatic patients were included. Data extraction and synthesis: Two independent reviewers extracted data and assessed risk of bias. Meta-analysis was performed to determine the prevalence of COVID-19 with 95% CI. Moreover, estimated positive predictive value (PPV), negative predictive value, false-positives (FP) and false-negatives were calculated for preoperative asymptomatic patients. Results: Twenty-seven studies containing 27 256 asymptomatic preoperative screened patients were included, of which 431 were positive for COVID-19 by RT-PCR test. In addition, the meta-analysis revealed a pooled COVID-19 prevalence of 0.76% (95% CI 0.36% to 1.59%). The calculated PPV for this prevalence is 40.8%. Conclusions: The pooled COVID-19 prevalence in asymptomatic patients tested preoperatively was 0.76%, with low corresponding PPV. Consequently, nearly three-quarters of postponed surgical procedures in asymptomatic preoperative patients may be FP. In the event of similar pandemics, modification of preoperative mandatory RT-PCR COVID-19 testing in asymptomatic patients may be considered.
MeSH term(s)	COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19 Testing ; Humans ; Pandemics ; Prevalence ; SARS-CoV-2
Language	English
Publishing date	2022-07-07
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-058389
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Article ; Online: Systematic review and meta-analysis determining the effect of implemented COVID-19 guidelines on surgical oncology volumes and clinical outcomes.

de Bock, Ellen / Herman, Eline S / Bastian, Okan W / Filipe, Mando D / Vriens, Menno R / Richir, Milan C

Surgical oncology

2022 Volume 45, Page(s) 101859

Abstract: Background: To provide for Coronavirus Disease 2019 (COVID-19) healthcare capacity, (surgical oncology) guidelines were established, forcing to alter the timing of performing surgical procedures. It is essential to determine whether these guidelines ... ...

Abstract	Background: To provide for Coronavirus Disease 2019 (COVID-19) healthcare capacity, (surgical oncology) guidelines were established, forcing to alter the timing of performing surgical procedures. It is essential to determine whether these guidelines have led to disease progression. This study aims to give an insight into the number of surgical oncology procedures performed during the pandemic and provide information on short-term clinical outcomes. Materials and methods: A systematic literature search was performed on all COVID-19 articles including operated patients, published before March 21, 2022. Meta-analysis was performed to visualize the number of performed surgical oncology procedures during the pandemic compared to the pre-pandemic period. Random effects models were used for evaluating short-term clinical outcomes. Results: Twenty-four studies containing 6762 patients who underwent a surgical oncology procedure during the pandemic were included. The number of performed surgical procedures for an oncological pathology decreased (-26.4%) during the pandemic. The number of performed surgical procedures for breast cancer remained stable (+0.3%). Moreover, no difference was identified in the number of ≥T2 (OR 1.00, P = 0.989), ≥T3 (OR 0.95, P = 0.778), ≥N1 (OR 1.01, P = 0.964) and major postoperative complications (OR 1.55, P = 0.134) during the pandemic. Conclusion: The number of performed surgical oncology procedures during the COVID-19 pandemic decreased. In addition, the number of performed surgical breast cancer procedures remained stable. Oncological staging and major postoperative complications showed no significant difference compared to pre-pandemic practice. During future pandemics, the performed surgical oncology practice during the first wave of the COVID-19 pandemic seems appropriate for short-term results.
MeSH term(s)	Humans ; Female ; COVID-19 ; Pandemics ; SARS-CoV-2 ; Surgical Oncology ; Postoperative Complications ; Breast Neoplasms
Language	English
Publishing date	2022-10-04
Publishing country	Netherlands
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	1107810-8
ISSN	1879-3320 ; 0960-7404
ISSN (online)	1879-3320
ISSN	0960-7404
DOI	10.1016/j.suronc.2022.101859
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Article: Evaluation of PET/CT in patients with stage III malignant cutaneous melanoma.

Groen, Lennaert Cb / Lazarenko, Sergiy V / Schreurs, Hermien Wh / Richir, Milan C

American journal of nuclear medicine and molecular imaging

2019 Volume 9, Issue 2, Page(s) 168–175

Abstract: In order to evaluate if patients with stage III-IV MCM are eligible for curative treatment PET/CT is performed. Since the diagnostic value of PET/CT is not unambiguously, a retrospective cohort study is performed to tailor optimal indication of PET/CT in ...

Abstract	In order to evaluate if patients with stage III-IV MCM are eligible for curative treatment PET/CT is performed. Since the diagnostic value of PET/CT is not unambiguously, a retrospective cohort study is performed to tailor optimal indication of PET/CT in patients with stage III MCM. A retrospective cohort study was conducted of all patients with stage III disease in a large oncologic teaching hospital in which PET/CT was performed from 2012 to 2016. The primary tumor- and regional lymph node characteristics were assessed to predict distant metastasis seen on PET/CT. A total of 73 patients were included of which 18% were restaged as stage IV by PET/CT. Twenty percent of the patients with a positive lymph node and 14% of patients with in transit metastasis or satellite lesions were restaged to stage IV. T-classification, ulceration and N-classification did not predict distant metastasis. Localization of the primary tumor significantly differed (P = 0.004). Localization on the head/neck resulted in a 32 greater odds of distant metastasis (P = 0.008). After a median follow-up of 36 months, 13 out of 60 (27%) stage III MCM patients were restaged as stage IV after the first performed PET/CT. This retrospective cohort study resulted in restaging of 18% of the stage III MCM patients by PET/CT, with therapeutic consequences. Patients with stage III MCM on the head/neck seem to have more distant spreading of the tumor than other localizations. Further investigation is needed, with larger sample sizes, to guide optimal indication of PET/CT.
Language	English
Publishing date	2019-04-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2623515-8
ISSN	2160-8407
ISSN	2160-8407
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Article ; Online: Risk factors of postoperative intensive care unit admission during the COVID-19 pandemic: A multicentre retrospective cohort study.

de Bock, Ellen / Filipe, Mando D / Herman, Eline S / Pronk, Apollo / Boerma, Djamila / Heikens, Joost T / Verheijen, Paul M / Vriens, Menno R / Richir, Milan C

International journal of surgery open

2023 Volume 55, Page(s) 100620

Abstract: Background: During the Coronavirus disease 2019 (COVID-19) pandemic, intensive care unit (ICU) capacity was scarce. Since surgical patients also require ICU admission, determining which factors lead to an increased risk of postoperative ICU admission is ...

Abstract	Background: During the Coronavirus disease 2019 (COVID-19) pandemic, intensive care unit (ICU) capacity was scarce. Since surgical patients also require ICU admission, determining which factors lead to an increased risk of postoperative ICU admission is essential. This study aims to determine which factors led to an increased risk of unplanned postoperative ICU admission during the COVID-19 pandemic. Methods: This multicentre retrospective cohort study investigated all patients who underwent surgery between 9 March 2020 and 30 June 2020. The primary endpoint was the number of surgical patients requiring postoperative ICU admission. The secondary endpoint was to determine factors leading to an increased risk of unplanned postoperative ICU admission, calculated by multivariate analysis with odds ratios (OR's) and 95% confidence (CI) intervals. Results: One hundred eighty-five (4.6%) of the 4051 included patients required unplanned postoperative ICU admission. COVID-19 positive patients were at an increased risk of being admitted to the ICU compared to COVID-19 negative (OR 3.14; 95% CI 1.06-9.33; p = 0.040) and untested patients (OR 0.48; 95% CI 0.32-0.70; p = 0.001). Other predictors were male gender (OR 1.36; 95% CI 1.02-1.82; p = 0.046), body mass index (BMI) (OR 1.05; 95% CI 1.02-1.08; p = 0.001), surgical urgency and surgical discipline. Conclusion: A confirmed COVID-19 infection, male gender, elevated BMI, surgical urgency, and surgical discipline were independent factors for an increased risk of unplanned postoperative ICU admission. In the event of similar pandemics, postponing surgery in patients with an increased risk of postoperative ICU admission may be considered.
Language	English
Publishing date	2023-05-05
Publishing country	England
Document type	Journal Article
ISSN	2405-8572
ISSN (online)	2405-8572
DOI	10.1016/j.ijso.2023.100620
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Article ; Online: The augmented value of using clinical notes in semi-automated surveillance of deep surgical site infections after colorectal surgery.

Verberk, Janneke D M / van der Werff, Suzanne D / Weegar, Rebecka / Henriksson, Aron / Richir, Milan C / Buchli, Christian / van Mourik, Maaike S M / Nauclér, Pontus

Antimicrobial resistance and infection control

2023 Volume 12, Issue 1, Page(s) 117

Abstract: Background: In patients who underwent colorectal surgery, an existing semi-automated surveillance algorithm based on structured data achieves high sensitivity in detecting deep surgical site infections (SSI), however, generates a significant number of ... ...

Abstract	Background: In patients who underwent colorectal surgery, an existing semi-automated surveillance algorithm based on structured data achieves high sensitivity in detecting deep surgical site infections (SSI), however, generates a significant number of false positives. The inclusion of unstructured, clinical narratives to the algorithm may decrease the number of patients requiring manual chart review. The aim of this study was to investigate the performance of this semi-automated surveillance algorithm augmented with a natural language processing (NLP) component to improve positive predictive value (PPV) and thus workload reduction (WR). Methods: Retrospective, observational cohort study in patients who underwent colorectal surgery from January 1, 2015, through September 30, 2020. NLP was used to detect keyword counts in clinical notes. Several NLP-algorithms were developed with different count input types and classifiers, and added as component to the original semi-automated algorithm. Traditional manual surveillance was compared with the NLP-augmented surveillance algorithms and sensitivity, specificity, PPV and WR were calculated. Results: From the NLP-augmented models, the decision tree models with discretized counts or binary counts had the best performance (sensitivity 95.1% (95%CI 83.5-99.4%), WR 60.9%) and improved PPV and WR by only 2.6% and 3.6%, respectively, compared to the original algorithm. Conclusions: The addition of an NLP component to the existing algorithm had modest effect on WR (decrease of 1.4-12.5%), at the cost of sensitivity. For future implementation it will be a trade-off between optimal case-finding techniques versus practical considerations such as acceptability and availability of resources.
MeSH term(s)	Humans ; Retrospective Studies ; Surgical Wound Infection/diagnosis ; Surgical Wound Infection/prevention & control ; Colorectal Surgery/adverse effects ; Cohort Studies ; Predictive Value of Tests
Language	English
Publishing date	2023-10-26
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2666706-X
ISSN	2047-2994 ; 2047-2994
ISSN (online)	2047-2994
ISSN	2047-2994
DOI	10.1186/s13756-023-01316-x
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