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Viewing a Person Through the Body: The Relevance of Philosophical Anthropology to Medical Education
Wim Dekkers 한국의학교육학회 2009 Korean journal of medical education Vol.21 No.4
Although the revival of medical humanities in the past three decades has emerged primarily in the US and the UK, continental Europe has a strong tradition in espousing the medical humanities, such as by advancing the anthropological movement in medicine and philosophy. In this paper, we argue that philosophical anthropology deserves a separate focus in medical education from medical ethics and philosophy of science. The focus of the paper is on the philosophical aspects of the human body to view a person ‘through the body.’ First, a short description of the anthropological movement in medicine is discussed, including its central motive ‘to introduce the subject into medicine.’ Next, the ontological and moral relationship between the person and his or her body is addressed. Drawing examples from anatomy, a so-called hemicorporectomy, organ donation, and aesthetic surgery, the concept of bodily integrity is expounded. These ideas can encourage medical students to discuss their own moral experiences during medical training and should be taught to enhance their philosophical understanding of medicine and health care.
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Lisette Dekker,Michiel T.J. Bak,Willem A. Bemelman,Richelle J.F. Felt-Bersma,Ingrid J.M. Han-Geurts 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.2
Purpose: Standard therapy for grade III hemorrhoids is rubber band ligation (RBL) and hemorrhoidectomy. The long-term clinical and patient-reported outcomes of these treatments in a tertiary referral center for proctology were evaluated. Methods: A retrospective analysis was performed in all patients with grade III hemorrhoids who were treated between January 2013 and August 2018. Medical history, symptoms, reinterventions, complications, and patient-reported outcome measurements (PROM) were retrieved from individual electronic patient files, which were prospectively entered as standard questionnaires in our clinic. Results: Overall, 327 patients (163 males) were treated by either RBL (n=182) or hemorrhoidectomy (n=145). The median follow-up was 44 months. The severity of symptoms and patient preference led to the treatment of choice. The most commonly experienced symptoms were prolapse (83.2%) and blood loss (69.7%). Hemorrhoidectomy was effective in 95.9% of the cases as a single procedure, while a single RBL procedure was only effective in 51.6%. In the RBL group, 34.6% received a second RBL session. Complications were not significantly different, 11 (7.6%) after hemorrhoidectomy versus 6 (3.3%) after RBL. However, 4 fistulas developed after hemorrhoidectomy and none after RBL (P<0.05). The pre-procedure PROM score was higher in the hemorrhoidectomy group whereas the post-procedure PROM score did not significantly differ between the groups. Conclusion: Treatment of grade III hemorrhoids usually requires more than one session RBL whereas 1-time hemorrhoidectomy suffices. Complications were more common after hemorrhoidectomy. The patient-related outcome did not differ between procedures.
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Experiences and outcomes in shoulder replacements in a district general hospital over 19 years
Andrew Peter Dekker,Jamie Hind,Neil Ashwood 대한견주관절학회 2024 대한견주관절의학회지 Vol.27 No.3
Background: This study aimed to evaluate the changing experiences of shoulder surgeons working in a district general hospital. Methods: A consecutive series of 395 shoulders (225 male, 170 female) over a 19-year period (2000–2019) with a minimum follow-up of 2 years were analyzed. Outcome measures were length of stay, operating time, satisfaction visual analog score (VAS), pain VAS, Oxford Shoulder Score (OSS), Constant-Murley score, range of movement, complications, and implant survival. Results: The incidence of a diagnosis of osteoarthritis as the surgical indication increased over time. The number of cases by surgeon per year increased from three cases in 2,000 to a peak of 33 in 2011. Up to seven implant manufacturers were used. The incidence of hemiarthroplasties decreased, and more numerous reverse polarity and anatomic arthroplasties were performed (P<0.001). More glenoid and humeral components were cemented and more short-stem implants were used in later years (P<0.001). Length of stay was a median of 1 day with a trend towards daytime surgery in recent years. Patients were satisfied (VAS 8/10) and OSS improved by 8 points on average throughout the observation period. Conclusions: Despite frequent introductions of new implants, patient outcome, satisfaction, and complication rates remained good. There appears to be a need for large-scale, generalizable studies to understand why technological advancements leading to changes in implants do not influence clinical outcomes. Level of evidence: III.
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Frickmann, Hagen,Dekker, Denise,Boahen, Kennedy,Acquah, Samuel,Sarpong, Nimako,Adu-Sarkodie, Yaw,Schwarz, Norbert G.,May, Jü,rgen,Marks, Florian,Poppert, Sven,Wiemer, Dorothea F.,Hagen, Ralf M. Informa Healthcare 2013 Scandinavian journal of infectious diseases Vol.45 No.8
<P><I>Background:</I> Invasive enteropathogenic bacteria can cause systemic infections. Data from studies with PCR detection suggest, at least for Salmonella enterica, that blood culture may lead to underestimation in the tropics. Corresponding data are lacking for other invasive enteropathogenic bacteria. We compared classical blood culture and molecular methods for the diagnosis of blood infections. <I>Methods:</I> A real-time multiplex PCR for Salmonella spp., Shigella spp./entero- invasive Escherichia coli (EIEC), Yersinia spp., and Campylobacter jejuni was applied to 2321 retained blood culture samples from Ghanaian patients, after enrichment by automated culture. <I>Results:</I> PCR detected Salmonella DNA in 56 out of 58 pre-incubated Ghanaian blood cultures with growth of S. enterica. In 2 samples molecular diagnosis was only possible after 1:10 dilution. Twenty-two samples negative by blood culture and 1 positive with Micrococcus spp. were PCR-positive for Salmonella spp. In addition, 3 Shigella spp./EIEC, 2 Yersinia spp., and 1 C. jejuni were detected by PCR but not by culture growth. <I>Conclusions:</I> Real-time PCR was more sensitive in identifying invasive enteropathogenic bacteria than automated blood culture, which is hampered by a lack of evidence-based standardization of pre-analytic conditions in the tropics. Primary agar culture and Gram-staining prior to automated blood culture is advisable in cases where transportation times are long.</P>
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Kim, Jong-Joo,Dekkers, Jack C.M. Asian Australasian Association of Animal Productio 2013 Animal Bioscience Vol.26 No.11
A least squares regression interval mapping model was derived to detect quantitative trait loci (QTL) with a unique mode of genomic imprinting, polar overdominance (POD), under a breed cross design model in outbred mammals. Tests to differentiate POD QTL from Mendelian, paternal or maternal expression QTL were also developed. To evaluate the power of the POD models and to determine the ability to differentiate POD from non-POD QTL, phenotypic data, marker data and a biallelic QTL were simulated on 512 F2 offspring. When tests for Mendelian versus parent-of-origin expression were performed, most POD QTL were classified as partially imprinted QTL. The application of the series of POD tests showed that more than 90% and 80% of medium and small POD QTL were declared as POD type. However, when breed-origin alleles were segregating in the grand parental breeds, the proportion of declared POD QTL decreased, which was more pronounced in a mating design with a small number of parents ($F_0$ and $F_1$). Non-POD QTL, i.e. with Mendelian or parent-of-origin expression (complete imprinting) inheritance, were well classified (>90%) as non-POD QTL, except for QTL with small effects and paternal or maternal expression in the design with a small number of parents, for which spurious POD QTL were declared.
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Cai, W.,Wu, H.,Dekkers, J.C.M. Asian Australasian Association of Animal Productio 2011 Animal Bioscience Vol.24 No.1
A selection experiment for reduced residual feed intake (RFI) in Yorkshire pigs consisted of a line selected for lower RFI (LRFI) and a random control line (CTRL). Longitudinal measurements of daily feed intake (DFI) and body weight (BW) from generation 5 of this experiment were used. The objectives of this study were to evaluate the use of random regression (RR) and nonlinear mixed models to predict DFI and BW for individual pigs, accounting for the substantial missing information that characterizes these data, and to evaluate the effect of selection for RFI on BW and DFI curves. Forty RR models with different-order polynomials of age as fixed and random effects, and with homogeneous or heterogeneous residual variance by month of age, were fitted for both DFI and BW. Based on predicted residual sum of squares (PRESS) and residual diagnostics, the quadratic polynomial RR model was identified to be best, but with heterogeneous residual variance for DFI and homogeneous residual variance for BW. Compared to the simple quadratic and linear regression models for individual pigs, these RR models decreased PRESS by 1% and 2% for DFI and by 42% and 36% for BW on boars and gilts, respectively. Given the same number of random effects as the polynomial RR models, i.e., two for BW and one for DFI, the non-linear Gompertz model predicted better than the polynomial RR models but not as good as higher order polynomial RR models. After five generations of selection for reduced RFI, the LRFI line had a lower population curve for DFI and BW than the CTRL line, especially towards the end of the growth period.
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Mariette Labots,Kristy J Gotink,Henk Dekker,Kaamar Azijli,Johannes C van der Mijn,Charlotte M Huijts,Sander R Piersma,Connie R Jiménez,Henk MW Verheul 생화학분자생물학회 2016 Experimental and molecular medicine Vol.48 No.-
Personalized cancer medicine aims to accurately predict the response of individual patients to targeted therapies, including tyrosine kinase inhibitors (TKIs). Clinical implementation of this concept requires a robust selection tool. Here, using both cancer cell lines and tumor tissue from patients, we evaluated a high-throughput tyrosine kinase peptide substrate array to determine its readiness as a selection tool for TKI therapy. We found linearly increasing phosphorylation signal intensities of peptides representing kinase activity along the kinetic curve of the assay with 7.5–10 μg of lysate protein and up to 400 μM adenosine triphosphate (ATP). Basal kinase activity profiles were reproducible with intra- and inter-experiment coefficients of variation of o15% and o20%, respectively. Evaluation of 14 tumor cell lines and tissues showed similar consistently high phosphorylated peptides in their basal profiles. Incubation of four patient-derived tumor lysates with the TKIs dasatinib, sunitinib, sorafenib and erlotinib primarily caused inhibition of substrates that were highly phosphorylated in the basal profile analyses. Using recombinant Src and Axl kinase, relative substrate specificity was demonstrated for a subset of peptides, as their phosphorylation was reverted by co-incubation with a specific inhibitor. In conclusion, we demonstrated robust technical specifications of this high-throughput tyrosine kinase peptide microarray. These features required as little as 5–7 μg of protein per sample, facilitating clinical implementation as a TKI selection tool. However, currently available peptide substrates can benefit from an enhancement of the differential potential for complex samples such as tumor lysates. We propose that mass spectrometry-based phosphoproteomics may provide such an enhancement by identifying more discriminative peptides.
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