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36 results on '"Zwaveling, Jan Harm"'

8. Data in de zorg en zorg voor de data

Author

Verbeek, Peter-Paul, Van Houdenhoven, Mark, Zwaveling, Jan Harm, and Philosophy

Abstract

Digitale technologie heeft een steeds grotere invloed op onze samenleving. En daarmee op de zorg. De ‘vierde industriele revolutie,’ zoals de digitalisering wordt genoemd, verbindt de digitale wereld met de fysieke wereld. Het internet koppelt niet meer slechts mensen aan elkaar, maar ook de dingen: van sensoren op ons lichaam tot de verlichting in gebouwen. En onze interactie met computers gaat niet meer uitsluitend via beeldschermen en toetsenborden, maar ook via robots die mensen gezelschap kunnen houden en die artsen kunnen helpen met opereren.

Published
2020

12. Systemic side effects of isolated limb perfusion with tumor necrosis factor alpha

Author

Zwaveling, Jan Harm, Zwaveling, Jan Harm, Zwaveling, Jan Harm, and Zwaveling, Jan Harm

Abstract

The main function of tumor necrosis factor alpha (TNF-a), a small polypeptide shared by all mammals, is probably protection against invading bacteria, parasites and viruses; killing of these microorganisms is facilitated in the presence of TNF-a. However, as its name suggest, TNF-a is also capable of killing tumor cells, in vitro as well as in vivo. This unique capacity has focused the attention on a possible role for this cytokine in the treatment of human cancer. ... Zie: Samenvatting.

Published
1997

13. HLA-DR expression on monocytes and systemic inflammation in patients with ruptured abdominal aortic aneurysms

Author

Haveman, Jan Willem, van den Berg, Aad P., Verhoeven, Eric L. G., Nijsten, Maarten W. N., van den Dungen, Jan J. A. M., The, T. Hauw, and Zwaveling, Jan Harm

Subjects
SEPSIS, SURGERY, MORTALITY, SEPTIC SHOCK, ANTIINFLAMMATORY RESPONSE, ENDOVASCULAR REPAIR, CYTOKINE PRODUCTION, RANDOMIZED CONTROLLED-TRIAL, ORGAN FAILURE, TRAUMA
Abstract

Introduction Mortality from ruptured abdominal aortic aneurysms (RAAA) remains high. Severe systemic inflammation, leading to multi-organ failure, often occurs in these patients. In this study we describe the level of HLA-DR expression in a consecutive group of patients following surgery for RAAA and compare results between survivors and non-survivors. A similar comparison is made for IL-6 and IL-10 levels and Sequential Organ Failure Assessment (SOFA) scores. Methods This is a prospective observational study. Patients with RAAA were prospectively analysed. Blood samples were collected on days 1, 3, 5, 7, 10 and 14. The fraction of CD-14 positive monocytes expressing HLA-DR was measured by flow-cytometry. IL-6 and IL-10 levels were measured by ELISA. Results The study included 30 patients with a median age of 70 years, of which 27 (90%) were men. Six patients died from multiple organ failure, all other patients survived. The SOFA scores were significantly higher in non-survivors on days 1 through 14. HLA-DR expression on monocytes was significantly lower on days 3, 5, 7, 10 and 14 in non-survivors. IL-6 and IL-10 levels were significantly higher in non-survivors on day 1 and days 1 and 3, respectively. Conclusion HLA-DR expression on monocytes was decreased, especially in non-survivors. All patients with RAAA displayed a severe inflammatory and anti-inflammatory response with an increased production of IL-6 and IL-10. Poor outcome is associated with high levels of IL-6 and IL-10 and a high SOFA score in the first three days after surgery, while low levels of HLA-DR expression are observed from day three after RAAA repair.

Published
2006

17. Professionalism beyond medical school: An educational continuum?

Author

van Mook, Walther N.K.A., primary, Gorter, Simone L., additional, de Grave, Willem S., additional, van Luijk, Scheltus J., additional, O'Sullivan, Helen, additional, Wass, Valerie, additional, Zwaveling, Jan Harm, additional, Schuwirth, Lambert W., additional, and der Vleuten, Cees P.M. van, additional

Published
2009
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21. Skin Lesions due to Exposure to Methyl Bromide

Author

Hezemans-Boer, Marianne, Toonstra, Johan, Meulenbelt, Jan, Zwaveling, Jan-Harm, Sangster, Bart, and van Vloten, Willem A.

Abstract

† Six patients were occupationally exposed to high concentrations of methyl bromide during a fumigation procedure using adequate airway protection. Within a few hours all patients developed skin lesions, consisting of sharply demarcated erythema with multiple vesicles and large bullae. There was a striking predisposition for parts of the skin that were relatively moist or subject to mechanical pressure, such as axillae, groin, and abdomen. Microscopically, early skin lesions revealed necrosis of keratinocytes, severe edema of the upper dermis, subepidermal blistering, and diffuse infiltration of neutrophils and, to a lesser degree, eosinophils. Two patients developed an urticarial rash approximately one week after the exposure. On histologic examination, these late lesions showed combined features of a spongiotic dermatitis and urticaria. No immunopathologic manifestations were observed. In all patients, the skin returned to normal after four weeks, except for some residual hyperpigmentation. Plasma bromide levels after exposure strongly suggested percutaneous absorption of methyl bromide.(Arch Dermatol 1988;124:917-921)

Published
1988
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35. [Selective decontamination in the ICU: benefit of the doubt].

Author

Bergmans DC and Zwaveling JH

Subjects
Bacteremia epidemiology, Bacteremia mortality, Cross Infection epidemiology, Cross Infection mortality, Decontamination methods, Humans, Intensive Care Units, Anti-Bacterial Agents therapeutic use, Bacteremia prevention & control, Cross Infection prevention & control, Gastrointestinal Tract microbiology, Oropharynx microbiology
Abstract

Since its introduction in 1984, selective decontamination of the digestive tract has had clear supporters and opponents. De Smet et al. conducted a large national study in 13 Dutch intensive care units, investigating the effects of the following 3 regimens on mortality: standard treatment, selective decontamination of the digestive tract and selective oropharyngeal decontamination. The results showed decontamination to have a clear benefit in terms of reducing mortality. Based on these results, decontamination should be used in all intensive care patients.

Published
2009

36. Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients.

Author

Wittekamp BH, van Mook WN, Tjan DH, Zwaveling JH, and Bergmans DC

Subjects
Adult, Critical Illness, Humans, Intubation, Intratracheal adverse effects, Laryngeal Diseases prevention & control, Laryngeal Edema prevention & control, Laryngoscopy adverse effects, Respiration, Artificial adverse effects, Risk Factors, Tracheal Diseases etiology, Tracheal Diseases prevention & control, Device Removal adverse effects, Laryngeal Diseases etiology, Laryngeal Edema etiology
Abstract

Laryngeal edema is a frequent complication of intubation. It often presents shortly after extubation as post-extubation stridor and results from damage to the mucosa of the larynx. Mucosal damage is caused by pressure and ischemia resulting in an inflammatory response. Laryngeal edema may compromise the airway necessitating reintubation. Several studies show that a positive cuff leak test combined with the presence of risk factors can identify patients with increased risk for laryngeal edema. Meta-analyses show that pre-emptive administration of a multiple-dose regimen of glucocorticosteroids can reduce the incidence of laryngeal edema and subsequent reintubation. If post-extubation edema occurs this may necessitate medical intervention. Parenteral administration of corticosteroids, epinephrine nebulization and inhalation of a helium/oxygen mixture are potentially effective, although this has not been confirmed by randomized controlled trials. The use of non-invasive positive pressure ventilation is not indicated since this will delay reintubation. Reintubation should be considered early after onset of laryngeal edema to adequately secure an airway. Reintubation leads to increased cost, morbidity and mortality.

Published
2009
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