Cor J Kalkman

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

MD, PhD

About

585
Publications
114,260
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28,037
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Additional affiliations
September 1999 - February 2015
University Medical Center Utrecht
Position
  • Professor of Anesthesia Research

Publications

Publications (585)
Preprint
Full-text available
Purpose Continuous vital signs monitoring with wearable systems may improve early recognition of patient deterioration on hospital wards. The objective of this study was to determine whether the wearable Checkpoint Cardio’s CPC12S, can accurately measure heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), blood pressure (BP) and tempe...
Article
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Background Multiple preoperative calculators are available online to predict preoperative mortality risk for noncardiac surgical patients. However, it is currently unknown how these risk calculators perform across different raters. The current study investigated the interrater reliability of three preoperative mortality risk calculators in an elect...
Article
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Contact with the hospital is usually limited for patients after day care surgery. Dedicated smartphone applications can improve communication and possibly enhance outcomes. The objective of this retrospective study was to evaluate patients’ self-reported pain and nausea and assess the success of routine implementation of a smartphone application fo...
Preprint
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Background Postoperative pain has significant implications, including surgical complications, prolonged hospital stays, and increased healthcare costs. The severity of postoperative pain depends predominantly on the surgical procedure, with orthopedic surgeries posing an elevated risk for severe pain. This study aimed to identify orthopedic surgica...
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Background: Virtual hospital-at-home care might be an alternative to standard hospital care for patients with infectious diseases. In this study, we explore the potential for virtual hospital-at-home care and a potential design for this population. Methods: This was a retrospective cohort study of internal medicine patients suspected of infectious...
Article
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Background Technological advances have enabled continuous monitoring of vital signs (CMVS) by wearable, wireless devices on general hospital wards to facilitate early detection of clinical deterioration, which could potentially improve clinical outcomes. However, evidence on the impact of these CMVS systems on patient outcomes is limited. This rese...
Article
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Background: A post-anaesthesia care unit (PACU) may improve postoperative care compared with intermediate care units (IMCU) due to its dedication to operative care and an individualized duration of postoperative stay. The effects of transition from IMCU to PACU for postoperative care following intermediate to high-risk noncardiac surgery on length...
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Background Vital signs measurements on the ward are performed intermittently. This could lead to failure to rapidly detect patients with deteriorating vital signs and worsens long-term outcome. The aim of this study was to test the hypothesis that continuous wireless monitoring of vital signs on the postsurgical ward improves patient outcome. Meth...
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Background: As a result of increased life expectancy and improved care for patients suffering from chronic disease, the number of patients with multimorbidity requiring surgical intervention is increasing. For complex surgical patients, it is essential to balance the potential benefits of surgical treatment against the risk of permanent loss of fu...
Preprint
Full-text available
Contact with the hospital is usually limited for patients after daycare surgery. Dedicated smartphone applications can improve communication and possibly enhance outcomes. The objective of this retrospective study was to evaluate patients’ self-reported pain and nausea and assess the success of routine implementation of a smartphone application for...
Article
Full-text available
Background Continuous monitoring of vital signs is introduced at general hospital wards to detect patient deterioration. Interpretation and response currently rely on experience and expert opinion. This study aims to determine whether consensus exist among hospital professionals regarding the interpretation of vital signs of COVID-19 patients. In a...
Article
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Background Continuous monitoring of vital signs (CMVS) using wearable wireless sensors is increasingly available to patients in general wards and can improve outcomes and reduce nurse workload. To assess the potential impact of such systems, successful implementation is important. We developed a CMVS intervention and implementation strategy and eva...
Article
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Objectives Failure to rescue deteriorating patients in hospital is a well-researched topic. We aimed to explore the impact of safer care on health economic considerations for clinicians, providers and policymakers. Design We undertook a rapid review of the available literature and convened a round table of international specialists in the field in...
Article
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Background The majority of surgical interventions are performed in day care and patients are discharged after the first critical postoperative period. At home, patients have limited options to contact healthcare providers in the hospital in case of severe pain and nausea. A smartphone application for patients to self-record pain and nausea when at...
Article
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Estimating pre‐operative mortality risk may inform clinical decision‐making for peri‐operative care. However, pre‐operative mortality risk prediction models are rarely implemented in routine clinical practice. High predictive accuracy and clinical usability are essential for acceptance and clinical implementation. In this systematic review, we iden...
Article
Background: Mortality, morbidity, and organ failure are important and common serious harms after surgery. However, there are many candidate measures to describe these outcome domains. Definitions of these measures are highly variable, and validity is often unclear. As part of the International Standardised Endpoints in Perioperative Medicine (StEP...
Preprint
BACKGROUND Wireless vital signs sensors are increasingly used for monitoring surgical ward patients. Although early warning scores (EWS) are the current standard for identification of patient deterioration in a ward setting, their usefulness for continuous monitoring is unknown. OBJECTIVE This study investigated the predictive value of early warni...
Article
Full-text available
Background Wireless vital sign sensors are increasingly being used to monitor patients on surgical wards. Although early warning scores (EWSs) are the current standard for the identification of patient deterioration in a ward setting, their usefulness for continuous monitoring is unknown. Objective This study aimed to explore the usability and pred...
Article
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Background Medical schools seek the best curricular designs for the transition to postgraduate education, such as the Dutch elective-based final, ‘transitional’ year. Most Dutch graduates work a mean of three years as a physician-not-in-training (PNIT) before entering residency training. To ease the transition to selected specialties and to decreas...
Preprint
BACKGROUND Continuous monitoring of vital signs (CMVS) using wearable wireless sensors is increasingly available to patients in general wards and can improve outcomes and reduce nurse workload. To assess the potential impact of such systems, successful implementation is important. We developed a CMVS intervention and implementation strategy and eva...
Article
Continuous monitoring of vital signs with wearable wireless sensors is increasingly being applied on general nursing wards. Although alarms are considered important for early detection of clinical deterioration, 'alarm fatigue' can seriously hamper the implementation of continuous monitoring. Current systems regularly generate high false alarm freq...
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Background: Continuous monitoring of vital signs has the potential to assist in the recognition of deterioration of patients admitted to the general ward. How to efficiently process and use continuously measured vital sign data is still unknown. Objective: To explore methods to summarise continuously measured vital sign data, and evaluate their...
Preprint
Full-text available
Background: The majority of surgical interventions are performed in day care and patients are discharged after the first critical postoperative period. At home, patients have limited options to contact healthcare providers in the hospital in case of severe pain and nausea. A smartphone application for patients to self-record pain and nausea when at...
Article
Full-text available
Rationale Vital signs follow circadian patterns in both healthy volunteers and critically ill patients, which seem to be influenced by disease severity in the latter. In this study we explored the existence of circadian patterns in heart rate, respiratory rate and skin temperature of hospitalized COVID-19 patients, and aimed to explore differences...
Article
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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
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 To support early recognition of clinical deterioration on a general ward continuous vital signs monitoring (CMVS) systems using wearable devices are increasingly being investigated. Although nurses play a crucial role in successful implementation, reported nurse adoption and acceptance scores vary significantly. In-depth insight into the...
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 oft...
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...
Article
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Background: To ensure availability of hospital beds and improve COVID-19 patients' well-being during the ongoing pandemic, hospital care could be offered at home. Retrospective studies show promising results of deploying remote hospital care to reduce the number of days spent in the hospital, but the beneficial effect has yet to be established. M...
Article
Background Outcome selection underpins clinical trial interpretation. Inconsistency in outcome selection and reporting hinders comparison of different trials' results, reducing the utility of research findings. Methods We conducted an iterative consensus process to develop a set of Core Outcome Measures for Perioperative and Anaesthetic Care (COMP...
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Purpose Preoperative multidisciplinary team (MDT) meetings are recommended for patients at high risk for perioperative complications and mortality, although the underlying evidence is scarce. We aimed to investigate the effect of MDT decisions on patient management and patient outcome. Methods We conducted a single-centre retrospective cohort stud...
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
Full-text available
Background: Thyroid storm is a feared complication in patients with hyperthyroidism undergoing surgery. We assessed the risk of thyroid storm for different preoperative treatment options for patients with primary hyperthyroidism undergoing surgery. Methods: Pubmed, EMBASE, and The Cochrane Library were searched systematically for all studies rep...
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
( Eur J Anaesthesiol . 2020;37:743–751) Current anesthesia practice often involves neuraxial techniques such as spinal anesthesia and epidural analgesia. The leading anesthetic technique for cesarean delivery remains spinal anesthesia, while chronic pain treatments include spinal cord stimulators, epidural injections, and intrathecal drug delivery...
Preprint
Full-text available
Background To support early recognition of clinical deterioration on a general ward continuous vital signs monitoring (CMVS) systems using wearable devices are increasingly being investigated. Although nurses play a crucial role in successful implementation, reported nurse adoption and acceptance scores vary significantly. In-depth insight into the...
Article
Thuismeting van zuurstofsaturatie bij COVID-19-patiënten neemt momenteel een vlucht in de huisartsenpraktijk. Het is een praktisch middel om patiënten thuis te monitoren. De validiteit van de saturatiemetingen vormt echter een punt van zorg. Daarnaast verdient wetenschappelijke onderbouwing van de toegevoegde waarde van thuismeting van zuurstofsatu...
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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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Objective To determine feasibility, in terms of acceptability and system fidelity, of continuous vital signs monitoring in abdominal surgery patients on a general ward. Design Observational cohort study. Setting Tertiary teaching hospital. Participants Postoperative abdominal surgical patients (n=30) and nurses (n=23). Interventions Patients we...
Article
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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...
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
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Postoperative pain management and pain assessment are still lacking the perspective of the patient. We have developed and studied a prototype smartphone application for patients to self-record postoperative pain. The main objective was to collect patient and stakeholder critique of improvements on the usability in order to develop a definitive vers...
Preprint
Full-text available
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: An association between increasing anaesthetic depth and decreased postoperative survival has been shown in observational studies; however, evidence from randomised controlled trials is lacking. Our aim was to compare all-cause 1-year mortality in older patients having major surgery and randomly assigned to light or deep general anaesth...
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...
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 stra...
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...