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In Panorama van de wetenschap vertellen specialisten en kenners verhalen over wonderlijke, vernuftige en zeldzame museumstukken. Deze verhalen laten zien hoe onderzoekers gefascineerd werden door de wereld om hen heen en hoe ze probeerden om deze beter te begrijpen. Zo ontstaat een brede blik op de ontwikkeling van de wetenschap, vanaf de vroege zeventiende eeuw tot Nobelprijswinnend onderzoek van vandaag.

In Panorama van de wetenschap vertellen specialisten en kenners verhalen over wonderlijke, vernuftige en zeldzame museumstukken. Deze verhalen laten zien hoe onderzoekers gefascineerd werden door de wereld om hen heen en hoe ze probeerden om deze beter te begrijpen. Zo ontstaat een brede blik op de ontwikkeling van de wetenschap, vanaf de vroege zeventiende eeuw tot Nobelprijswinnend onderzoek van vandaag.

Performance Budgeting has been introduced to gain greater managerial control over the outcomes and efficiency of policies and their budgets. Strikingly, a growing body of literature has explained that politicians hardly use performance information or only to emotionally judge government performance. We, however, propose understanding the emotional use of performance information as catharsis. Catharsis is the ritual of emotional and moral judging to understand and initiate improvement. Catharsis has been named as an important function of accountability, but has not been researched in the field of Public Administration. We discuss the concept of catharsis in relation to accountability and show that, by using evidence from its role in Dutch parliament, the use of ‘cathartic emotions’ are omnipresent in financial debates, especially when parliamentary enquiries and annual budgets are debated. Based on these findings catharsis should be understood as a much more serious function of accountability by both academics and public officials.

To study the effect of the first COVID-19 wave in combination with the lockdown on acute care in the Netherlands.Retrospective cohort study METHOD: For this study, data was collected from patients who visited the emergency department (ED) and Cardiac Care Unit of Noordwest Ziekenhuisgroep in Alkmaar and Den Helder. This data collection took place from 1 February to 28 June in 2019 and during the same period in 2020. The number of visits per day was investigated. The outcome measures for hospital occupation were the number of admissions per day and the average length of stay. Outcome measures for health damage were length of stay and mortality.The number of ED visits fell by 27% during the lockdown. For the specialties of internal medicine and pulmonary medicine, the number of admissions from the ED was the same during the lockdown, but the length of stay was longer. For all other specialties, the number of admissions from the ED was lower during the lockdown, but the admission duration was the same. Mortality was higher and hospital stay longer for patients admitted to the specialties of internal medicine and pulmonary medicine. In all other specialisms studied, there was no higher mortality or longer hospital stay.From the start of the lockdown, there was a sharp drop in the number of ED visits. The number of ED visits recovered slowly after this drop. For specialties that did not treat COVID-19 patients, hospital occupation was lower than usual. The number of admissions from the ED had decreased for these specialties. Based on the outcome measures length of stay and mortality, we were unable to find any indications of health damage as a result of the drop in admissions.

Early Warning Scores (EWSs) are based on the assumption that critical illness is preceded by physical deterioration. The question is whether measuring 5 vital parameters several times a day can predict changes in a highly complex and dynamic clinical condition. Little evidence has yet been found for clinical superiority of current EWSs over good clinical assessment. If we want to predict better and act structurally proactively, the measurement frequency of vital parameters must increase and much more complex scores are needed to identify specific changes in individual patients at an early stage. It is plausible that the many innovative developments in this area are the stepping stone to an era in which care in regular nursing wards is increasingly directed in the right direction by predictive algorithms. Integration of such super EWSs in new working methods may contribute to continuously adaptive care that is ultimately better and more efficient and relieves the care provider.

To examine if the medical disciplinary law in the Netherlands is becoming tougher.Observational study.We read the annual reports of the Dutch Disciplinary Committees for the Healthcare Sector 2007-2017, and registered the numbers of disciplinary cases and those cases upheld, the measures imposed and the degree of consistency in the event of an appeal. Over 400 medical disciplinary cases were reviewed in more detail. Based on these cases, we determined those variables that increase or decrease the likelihood of conviction, such as the gender of the defendants, the region in which the disciplinary case was heard, and if objective norms and professional practice guidelines had been used in arriving at the verdict.Each year a disciplinary case is brought against an average of 0.4% of all health care providers - mainly physicians (an average of approximately 1400 disciplinary cases each year). One-third of all disciplinary cases were dealt with in court and about half of them were upheld. Over time, the number of disciplinary cases has increased (36%), as has the percentage of cases that are upheld (27%). Additionally, heavier measures were more often imposed and the degree of consistency between the initial ruling and the ruling on appeal also increased (56%). Those factors that increased the likelihood of a case being upheld were: being a physician of male gender, the disciplinary case being heard in The Hague or Eindhoven, and the non-implementation of an objective norm or professional practice guideline in arriving at the verdict.Since 2007 the Dutch medical disciplinary boards have been punishing more often and more severely. This may be because the subjective demands made on health care professionals have changed. Arriving at an opinion subjectively is not a problem when it comes to verifying compliance with standards of due care. However, if this method is used to determine the penalty, the health care system will become defensive - and this will not improve the quality of care.

Endovenous treatment has become the treatment of choice for patients with saphenous varicose veins (great saphenous vein and small saphenous vein). Current thermal treatment modalities are endovenous laser ablation, radiofrequency ablation and steam ablation. These treatments work by heating the vein, causing the vessel to become occluded. These thermal treatment methods require tumescent anaesthesia. The outstanding effectiveness of laser and radiofrequency ablation has now been demonstrated in countless randomised trials and meta-analyses. Steam ablation seems to be just as effective as the other thermal treatment methods, but there is less pain afterwards. Since the treatment is not reimbursed, steam ablation is currently not used in the Netherlands.

Er is veel onderzoek gedaan naar de ervaringen van patiënten die een klacht indienen over een ziekenhuis.1-6 Veel minder is er bekend over de manier waarop huisartsen reageren op een klacht. Uit onderzoek weten we dat iets meer dan de helf van de patiënten een vervelende ervaring naderhand met de eigen huisarts bespreekt en dat daarvan weer ongeveer de helf tevreden is met diens reactie.6,7 Maar we weten weinig over de ervaringen van patiënten van wie de klacht niet naar tevredenheid wordt opgelost. In het kader van het Nivel-project ‘Openheid in de huisartsenzorg’ onderzochten wij de vraag: ‘Wat zijn de belangrijkste ervaringen van klagers met het indienen van een klacht over de zorgverlening door een huisarts of vanuit een huisartsenpost?’

A 23-year-old woman had a painful, growing mass close to the nail of her left index finger. The differential diagnosis consisted of acquired digital fibrokeratoma, digital fibromyxoma, periungual fibroma or verruca vulgaris. Surgical excision of the mass was performed, and histopathological analysis revealed a subungual exostosis.

Platelet aggregation inhibitors, also known as antiplatelet therapy (APT), are prescribed for the prevention of secondary cardiovascular events (CVE) after endovascular revascularization procedures.- Platelet aggregation inhibitors are not equally effective in all patients. The phenomenon of high residual platelet reactivity despite APT is called 'high on-treatment platelet reactivity' (HTPR); it bears an increased risk of secondary CVE.- Platelet function tests (PFT) can be used to diagnose HTPR. There are various tests available; of those, light transmission aggregometry (LTA) is considered the gold standard. Some tests are only suitable for determining the effect of a certain category of APT.- Research into the usefulness of PFTs to optimise treatment with APT has not yet produced an unambiguous conclusion.- Currently there is not yet an indication for routine use of PFT in clinical practice. However, for the treatment of certain categories of patients with thromboembolic disease - such as those with renal failure or a history of kidney transplant - PFT can be considered.

Chronic diseases and multimorbidity are common and expected to rise over the coming years. The objective of this study is to examine the time trend in the prevalence of chronic diseases and multimorbidity over the period 2001 till 2011 in the Netherlands, and the extent to which this can be ascribed to the aging of the population.Monitoring study, using two data sources: 1) medical records of patients listed in a nationally representative network of general practices over the period 2002-2011, and 2) national health interview surveys over the period 2001-2011. Regression models were used to study trends in the prevalence-rates over time, with and without standardization for age.An increase from 34.9% to 41.8% (p0.01) in the prevalence of chronic diseases was observed in the general practice registration over the period 2004-2011 and from 41.0% to 46.6% (p0.01) based on self-reported diseases over the period 2001-2011. Multimorbidity increased from 12.7% to 16.2% (p0.01) and from 14.3% to 17.5% (p0.01), respectively. Aging of the population explained part of these trends: about one-fifth based on general practice data, and one-third for chronic diseases and half of the trend for multimorbidity based on health surveys.The prevalence of chronic diseases and multimorbidity increased over the period 2001-2011. Aging of the population only explained part of the increase, implying that other factors such as health care and society-related developments are responsible for a substantial part of this rise.

Up to thirty years ago, in the Netherlands the word 'stervensbegeleiding' [literally, dying-guidance] was used to refer to care for people in the last days of life. After Cicely Saunders had developed a multidisciplinary and multidimensional approach for care for the dying, the wording changed, until the word 'palliative care' was adopted. This care gradually developed from care for the dying to care for all people with life-threatening illness, as illustrated in the WHO definition. This shift in focus of care raises the question of when palliative care starts. The surprise question is regarded as a useful tool for marking this shift in focus of care. However, answering the surprise question does not inform us about palliative care needs. Nevertheless, when people enter the dying phase, a fundamental change in the nature of care is needed. The word 'stervensbegeleiding' marks this change of care.

Gastric wall abscesses are rare, but mortality rates from this type of gastritis are high. A foreign body or mucosal damage is often the cause of the abscess. Most patients have nonspecific symptoms, including general malaise and abdominal pain, sometimes accompanied by fever and weight loss.After various tests a 45-year-old man with epigastric pain was shown to have a gastric wall abscess. After endoscopic drainage of the abscess, followed by intravenous antibiotics, he made a complete recovery.Gastric wall abscesses are rare, but should be included in the differential diagnosis in patients with epigastric pain, because of their high mortality rate. Endoscopic ultrasonography is the preferred diagnostic method. Endoscopic ultrasound-guided drainage, with or without placement of a drain, followed by intravenous antibiotics is the treatment of choice.

Platelet aggregation inhibitors, also known as antiplatelet therapy (APT), are prescribed for the prevention of secondary cardiovascular events (CVE) after endovascular revascularization procedures.- Platelet aggregation inhibitors are not equally effective in all patients. The phenomenon of high residual platelet reactivity despite APT is called 'high on-treatment platelet reactivity' (HTPR); it bears an increased risk of secondary CVE.- Platelet function tests (PFT) can be used to diagnose HTPR. There are various tests available; of those, light transmission aggregometry (LTA) is considered the gold standard. Some tests are only suitable for determining the effect of a certain category of APT.- Research into the usefulness of PFTs to optimise treatment with APT has not yet produced an unambiguous conclusion.- Currently there is not yet an indication for routine use of PFT in clinical practice. However, for the treatment of certain categories of patients with thromboembolic disease - such as those with renal failure or a history of kidney transplant - PFT can be considered.

Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic vasculopathy that can lead to arterial stenosis, occlusion, aneurysms, and dissection. FMD of the renal arteries can lead to renovascular hypertension. Percutaneous angioplasty of the renal arteries (PTRA) can lead to normalization of blood pressure in 45% of patients with renal artery stenosis caused by FMD, particularly in younger patients and patients with a short history of hypertension. A considerable number of the patients with renovascular FMD also have cervical FMD, which can lead to ischaemic or haemorrhagic stroke. In this article we discuss diagnostic and therapeutic options, illustrated by two cases of patients with renovascular and carotid FMD. Most of the recommendations are based on data from retrospective studies and expert opinion; prospective studies on the optimal diagnostic strategy and treatment are therefore, urgently required.

To gain insight into how the acute care of critically ill children at general hospitals is organised, whether staff is sufficiently trained and whether the necessary materials and medications are present.Questionnaire combined with a site visit.Questionnaires were sent to all primarily involved specialists (emergency room specialists and paediatricians), and to the auxiliary anaesthetists and intensivists involved, at the nine general hospitals in Southeast Netherlands. Two researchers performed standardised interviews with the lead paediatricians on site and checked for materials and medication present in the emergency and paediatric departments.Of the 195 questionnaires sent, 97 (49.7%) were deemed suitable for analysis. The response from the primary specialists involved (77.6%) was more than twice that of the auxiliary specialists (31.9%). At 7 hospitals, verbal agreements on the organisation of acute care were maintained, 1 hospital had a written protocol, and 2 hospitals had a task force addressing this topic. One out of 5 respondents was unaware of the verbal agreements and 1 out of 3 mistakenly assumed that a protocol existed. Two out of 3 primary specialists involved were certified for Advanced Paediatric Life Support (APLS); 1 out of 13 of the auxiliary specialists had such a certificate. Scenario training was being conducted at 8 hospitals. A paediatric resuscitation cart was available at both the emergency and paediatric departments of 8 hospitals, 3 of which were fully stocked at both departments. Laryngeal mask airways and PEEP-valves (Positive End Expiratory Pressure) were lacking at 6 of the 9 hospitals. The medication stock was complete at all the hospitals.The organisation of and training for the acute care of critically ill children and presence of materials - the aspects we investigated - need attention at all general hospitals evaluated. It appeared that many specialists are not APLS certified and written protocols concerning organisation and training were lacking. The establishment of a task force responsible for the acute care of children is one measure that could result in rapid improvement. Another measure could be the introduction of a standardised list of inventory needed for acute care.