Cor J Kalkman

Cor J Kalkman
University Medical Center Utrecht | UMC Utrecht · Department of Anesthesiology

MD, PhD

About

545
Publications
84,175
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21,859
Citations
Additional affiliations
September 1999 - February 2015
University Medical Center Utrecht
Position
  • Professor of Anesthesia Research

Publications

Publications (545)
Article
Background: With electronic technologies, patients are provided with tools to easily acquire information and to manage and record their own health status. eHealth interventions are already broadly applied to perioperative care. In a similar way, we aimed to utilize a smartphone application to enable postoperative patients to partially self-manage...
Article
Full-text available
Background: Wireless continuous vital sign monitoring by wearable devices have recently become available for patients on general wards to promote timely detection of clinical deterioration. Many continuous monitoring systems use conventional threshold alarm settings to alert nurses in case of deviating vital signs. However, frequent false alarms o...
Article
(Reg Anesth Pain Med. 2021;46:337–343. doi: 10.1136/rapm-2020-102154. Epub January 13, 2021) On occasion, neuraxial analgesia leads to severe complications and side effects such as intracranial hematoma or abscess. This study aimed to review literature cases describing intracranial hematomas or abscesses resulting from neuraxial block to analyze pa...
Preprint
BACKGROUND With electronic technologies, patients are provided with tools to easily acquire information, to manage and record their own health status. EHealth interventions are already broadly applied in perioperative care. In a similar way, we aimed to utilize an smartphone application for postoperative patients enabling them to partially self-man...
Article
Continuous and mobile monitoring of vital signs may soon become a reality on hospital wards. By enabling the early detection of clinical deterioration, it may improve quality of care and patient safety.
Article
Full-text available
Background Patients undergoing esophagectomy are at serious risk of developing postoperative complications. To support early recognition of clinical deterioration, wireless sensor technologies that enable continuous vital signs monitoring in a ward setting are emerging. Objective This study explored nurses’ and surgeons’ expectations of the potent...
Article
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Continuous vital signs monitoring in post-surgical ward patients may support early detection of clinical deterioration, but novel alarm approaches are required to ensure timely notification of abnormalities and prevent alarm-fatigue. The current study explored the performance of classical and various adaptive threshold-based alarm strategies to war...
Article
Full-text available
Background Besides spinal complications, intracranial hematoma or abscess may occur after neuraxial block. Risk factors and outcome remain unclear. Objective This review evaluates characteristics, treatment and recovery of patients with intracranial complications after neuraxial block. Evidence review We systematically searched MEDLINE, Embase an...
Article
Full-text available
Background Knowledge of risk factors for postoperative urinary retention may guide appropriate and timely urinary catheterization. We aimed to determine independent risk factors for postoperative urinary catheterization in general surgical patients. In addition, we calculated bladder filling rate and assessed the time to spontaneous voiding or cath...
Article
Background Adverse cardiovascular events are a leading cause of perioperative morbidity and mortality. The definitions of perioperative cardiovascular adverse events are heterogeneous. As part of the international Standardized Endpoints in Perioperative Medicine initiative, this study aimed to find consensus amongst clinical trialists on a set of s...
Article
Background: Severe complications after neuraxial anaesthesia are rare but potentially devastating. Objective: We aimed to identify characteristics and preventable causes of haematoma, abscess or meningitis after neuraxial anaesthesia. Design: Observational study, closed claims analysis. Setting: Closed anaesthesia malpractice claims from the...
Preprint
BACKGROUND Patients undergoing esophagectomy are at serious risk of developing postoperative complications. To support early recognition of clinical deterioration, wireless sensor technologies that enable continuous vital signs monitoring in a ward setting are emerging. OBJECTIVE This study explored nurses’ and surgeons’ expectations of the potent...
Article
Full-text available
Background Patients undergoing cerebral bypass surgery are prone to cerebral hypoperfusion. Currently, arterial blood pressure is often increased with vasopressors to prevent cerebral ischaemia. However, this might cause vasoconstriction of the graft and cerebral vasculature and decrease perfusion. We hypothesised that cardiac output, rather than a...
Preprint
Full-text available
BACKGROUND Hospital stay after major surgery is shorter than ever before. Although enhanced recovery and early discharge have many benefits, some complications will now first manifest themselves in the home setting. Remote patient monitoring in the first days after hospital discharge with wearable sensors may capture clinical deterioration earlier,...
Article
Full-text available
Background Hospital stays after major surgery are shorter than ever before. Although enhanced recovery and early discharge have many benefits, some complications will now first manifest themselves in home settings. Remote patient monitoring with wearable sensors in the first days after hospital discharge may capture clinical deterioration earlier b...
Preprint
Full-text available
Background If risk factors for postoperative urinary catheterization are known adverse events to the lower urinary tract may be prevented. Therefore, postoperative surgical patients were assessed for risk factors for urinary catheterization, for speed of bladder filling and for time till catheterization or spontaneous voiding. The individual maximu...
Preprint
Full-text available
Background Knowledge of risk factors for postoperative urinary retention may guide appropriate and timely urinary catheterization. We aimed to determine independent risk factors for postoperative urinary catheterization in general surgical patients. In addition, we calculated bladder filling rate and assessed the time to spontaneous voiding or cath...
Article
Full-text available
: Patient safety is an activity to mitigate preventable patient harm that may occur during the delivery of medical care. The European Board of Anaesthesiology (EBA)/European Union of Medical Specialists had previously published safety recommendations on minimal monitoring and postanaesthesia care, but with the growing public and professional intere...
Article
Full-text available
Main outcome: Thirty patients (60%) found it satisfying or very satisfying to communicate their pain with the app. Pain experienced after surgery was scored by patients as 'no': 3 (6%), 'little': 5 (10%), 'bearable': 25 (50%), 'considerable': 13 (26%) and 'severe': 1 (2%). Forty-five patients (90%) were positive about the ease of recording. Forty-...
Preprint
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The aim of a clinical decision support tool is to reduce the complexity of clinical decisions. However, when decision support tools are poorly implemented they may actually confuse physicians and complicate clinical care. This paper argues that information from decision support tools is often removed from the clinical context of the targeted decisi...
Article
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Background: Thoracic epidural analgesia is the standard postoperative pain management strategy in esophageal cancer surgery. However, paravertebral block analgesia may achieve comparable pain control while inducing less side effects, which may be beneficial for postoperative recovery. This study primarily aims to compare the postoperative quality...
Article
Full-text available
Background: Adverse events are common in high-risk surgical patients, but early detection is difficult. Recent innovations have resulted in wireless and 'wearable' sensors, which may capture patient deterioration at an early stage, but little is known regarding their ability to timely detect events. The objective of this study is to describe the a...
Article
Full-text available
What we already know about this topic: Changes in vital signs are an important indicator of physiological decline and hence provide opportunities for early recognition and intervention; however, in the hospital ward, vital signs are usually measured intermittently. In between such spot checks, early signs of deterioration may be missed.Several "we...
Article
Background: Patient-centred outcomes are increasingly used in perioperative clinical trials. The Standardised Endpoints in Perioperative Medicine (StEP) initiative aims to define which measures should be used in future research to facilitate comparison between studies and to enable robust evidence synthesis. Methods: A systematic review was cond...
Article
(Acta Anaesthesiol Scand. 2018;62:1466–1472) There is a trend to move away from neuraxial blocks in favor of truncal blocks, peripheral nerve blocks, and local anesthetic wound infiltration in the Netherlands. Furthermore, recent epidural “alert systems” have been introduced, meant to aid in the early detection of spinal hematoma or abscess after n...
Article
(Br J Anaesth. 2018;120:693–704) Incidences of spinal hematoma or abscess after central neuraxial block (CNB) are estimated to be low, with the former being 1:154,730 and the latter being so rare, it could not even be calculated in a major 2016 study. Because of the rarity, there is no evidence on which to base recommendations for management strate...
Article
Objective: Steroids suppress the inflammatory response to cardiopulmonary bypass, but the impact on death at 30 days, myocardial infarction or injury, stroke, renal failure, respiratory failure, new atrial fibrillation, transfusion requirement, infection, and length of intensive care unit (ICU) and hospital stays are uncertain. Design: Patient-l...
Article
Background: Clinical indicators are powerful tools to quantify the safety and quality of patient care. Their validity is often unclear and definitions extremely heterogeneous. As part of the International Standardised Endpoints in Perioperative Medicine (StEP) initiative, this study aimed to derive a set of standardised and valid clinical outcome...
Article
Background: Clinically significant deterioration of patients admitted to general wards is a recognized complication of hospital care. Rapid Response Systems (RRS) aim to reduce the number of avoidable adverse events. The authors aimed to develop a core quality metric for the evaluation of RRS. Methods: We conducted an international consensus pro...
Article
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Background: Remote monitoring of physical activity in patients with chronic conditions could be useful to offer care professionals real-time assessment of their patient's daily activity pattern to adjust appropriate treatment. However, the validity of commercially available activity trackers that can be used for telemonitoring purposes is limited....
Article
Background: Perioperative infection and sepsis are of fundamental concern to perioperative clinicians. However, standardised endpoints are either poorly defined or not routinely implemented. The Standardised Endpoints in Perioperative Medicine (StEP) initiative was established to derive a set of standardised endpoints for use in perioperative clin...
Article
Full-text available
Background: In laboratory animals, exposure to most general anaesthetics leads to neurotoxicity manifested by neuronal cell death and abnormal behaviour and cognition. Some large human cohort studies have shown an association between general anaesthesia at a young age and subsequent neurodevelopmental deficits, but these studies are prone to bias....
Article
Full-text available
Ultrasound scanning of bladder volume is used for prevention of postoperative urinary retention (POUR). Accurate assessment of bladder volume is needed to allow clinical decision-making regarding the need for postoperative catheterization. Two commonly used ultrasound devices, the BladderScan® BVI 9400 and the newly released Prime® (Verathon Medica...
Article
Full-text available
Purpose Altered respiratory rate (RR) has been identified as an important predictor of serious adverse events during hospitalization. Introduction of a well-tolerated continuous RR monitor could potentially reduce serious adverse events such as opioid-induced respiratory depression. The purpose of this study was to investigate the ability of differ...
Article
Background The clinical use of epidural analgesia has changed over past decades. Minimally invasive surgery and emergence of alternative analgesic techniques have led to an overall decline in its use. In addition, there is increasing awareness of the patient‐specific risks for complications such as spinal haematoma and abscess. Local guidelines for...
Article
Full-text available
An important aim of clinical prediction models is to positively impact clinical decision making and subsequent patient outcomes. The impact on clinical decision making and patient outcome can be quantified in prospective comparative—ideally cluster-randomized—studies, known as ‘impact studies’. However, such impact studies often require a lot of ti...
Article
Background: The Standardising Endpoints for Perioperative Medicine group was established to derive an appropriate set of endpoints for use in clinical trials related to anaesthesia and perioperative medicine. Anaesthetic or analgesic technique during cancer surgery with curative intent may influence the risk of recurrence or metastasis. However, g...
Article
Background: There is a need for robust, clearly defined, patient-relevant outcome measures for use in randomised trials in perioperative medicine. Our objective was to establish standard outcome measures for postoperative pulmonary complications research. Methods: A systematic literature search was conducted using MEDLINE, Web of Science, SciELO...
Article
Background: Maximising patient comfort during and after surgery is a primary concern of anaesthetists and other perioperative clinicians, but objective measures of what constitutes patient comfort in the perioperative period remain poorly defined. The Standardised Endpoints in Perioperative Medicine initiative was established to derive a set of st...
Article
Full-text available
Although rare, spinal haematoma and abscess after central neuraxial blocks may cause severe permanent neurological injury. Optimal treatment and outcome remain unclear. In order to identify possible predisposing patient characteristics and describe the ensuing clinical course, we searched Medline, Embase, and the Cochrane Library for reports of spi...
Article
Full-text available
Background and objectives Intermittent vital signs measurements are the current standard on hospital wards, typically recorded once every 8 hours. Early signs of deterioration may therefore be missed. Recent innovations have resulted in ‘wearable’ sensors, which may capture patient deterioration at an earlier stage. The objective of this study was...
Article
Full-text available
Objective: A well-designed final year may ease the transition from medical school to postgraduate training, if it has enough depth to enable the acquisition of early specialty expertise, while keeping enough breadth to support the graduation as all-round physician. Aim of this article is to describe the design of a multidisciplinary dedicated trans...
Data
Elaborated entrustable professional activity on evaluation of circulatory compromised patients
Data
Elaborated entrustable professional activity on recognition and initial treatment of vitally threatened patients
Data
Elaborated entrustable professional activity on evaluation of respiratory compromised patients
Article
Background: Previous studies provide inconsistent data on whether postoperative delirium (POD) is a risk factor for postoperative cognitive decline (POCD). We thus investigated the relationship between POD and cognitive change after cardiac surgery and assessed the relationship between preoperative cognitive domain scores and POD. Methods: Posto...
Article
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Background: Postgraduate specialty training has traditionally been based on a time- and rotation-based model, but competency-based models are emerging. Because anaesthesia training evolves differently across Europe, variations in assessment and certification processes are expected, but the extent of similarities and differences is unknown. The aim...
Article
Full-text available
Background and aims: Despite widespread use, the efficacy of neuraxial glucocorticoids for neuropathic pain is subject to debate. Since most glucocorticoid actions are mediated through its receptor, we explored the effects of intrathecal methylprednisolone acetate (MPA) on total glucocorticoid receptor (tGR) levels and activation of the glucocorti...
Article
Background and aim: In older patients undergoing elective cardiac surgery, timely identification and preparation of patients at risk for frequent postoperative hospital complications provides for the opportunity reducing their risk. We developed an evidence based multi component nursing intervention (PREDOCS-Program) to improve patients’ physical a...
Poster
Full-text available
TAKE HOME MESSAGE Assessment and certification processes in European anaesthesiology training are diverse. In many countries, a timebased apprenticeship model is evolving towards a competencybased certification process. This diversity complicates comparison of competence of graduating anaesthesiologists across Europe.
Article
Prophylactic intra-operative administration of dexamethasone may improve short-term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long-term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre, randomised, double-blind, placebo-controlled DExametha...
Article
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Importance Fibrinogen concentrate might partly restore coagulation defects and reduce intraoperative bleeding. Objective To determine whether fibrinogen concentrate infusion dosed to achieve a plasma fibrinogen level of 2.5 g/L in high-risk cardiac surgery patients with intraoperative bleeding reduces intraoperative blood loss. Design, Setting, a...
Article
Full-text available
Background: Serious games have the potential to teach complex cognitive skills in an engaging way, at relatively low costs. Their flexibility in use and scalability makes them an attractive learning tool, but more research is needed on the effectiveness of serious games compared to more traditional formats such e-modules. We investigated whether u...
Article
Full-text available
Aims and objectives: To describe patients' and nurses' knowledge and beliefs regarding pain management. Moreover, to explore the effect of information and education on patients' and nurses' knowledge and beliefs regarding pain management. Background: In the treatment of postoperative pain, patients' and nurses' inadequate knowledge and erroneous...
Chapter
Chapter on foundations of anesthesia for neurological surgery and ECT included in the Oxford Textbook of Anaesthesia, a major Textbook of Anesthesiology
Article
Full-text available
Altered respiratory rate is one of the first symptoms of medical conditions that require timely intervention, e.g., sepsis or opioid-induced respiratory depression. To facilitate continuous respiratory rate monitoring on general hospital wards a contactless, non-invasive, prototype monitor was developed using frequency modulated continuous wave rad...