Biomedical subjects

Benno Bonke

Publications and source records attributed to Benno Bonke.

6 recordsLinked to original sources

PubMed2006

Unprofessional or problematic behaviour of medical students outside the learning environment.

This paper focuses on the question what to do with unprofessional or problematic behaviour of medical students outside the learning environment. Examples are given to raise awareness of the problem and initiate possible solutions. It is advised that medical schools keep an open eye for problematic behaviour outside the learning environment, also because documented unprofessional behaviour during medical training is a predictor of professional misconduct as a physician. Part of this paper was presented by the author as 'Professionalism: between wearing blinkers and big brother' at the AMEE conference, Edinburgh, UK, September 2004.

Behavior↗

PubMed2006

Student diversity at Erasmus Medical Centre Rotterdam: does it make any difference?

In an ethnically diverse society cultural competence is indispensable for medical doctors. At present 10% of the Dutch population are first- or second-generation non-Western immigrants. With 8% Western and 18% non-Western immigrants, originating from 30 different countries, the 2001 Rotterdam first-year students highly out-rated the national average of immigrant medical students. Diverse student populations may enhance students' cultural competence but can also generate conflicts or even racism. This was the first Dutch study on expectations and experiences of medical students related to their ethnic and religious background. In December 2001 all first-year students were approached with an anonymous questionnaire, including statements on the expected influence of their culture and religion on their medical education (rated on a 1-5 Likert scale). In spring 2003 17 students from the same cohort, 8 immigrants and 9 ethnic Dutch, were interviewed extensively on their study experiences in a diverse student population. In 2001 the response rate was 90% (277/308), female-male ratio 63% (175/102). Non-Western immigrants expected for their medical education more benefits from their culture but also more obstacles than ethnic Dutch (p < or = 0.005). Protestants and Muslims expected more obstacles than the non-religious and Catholics (p < or = 0.05). In the interviews three main issues emerged: peer training in physical examination in mixed-gender groups, lack of attention to student diversity during education, and demand for education in cross-cultural medicine. Three incidents of perceived discrimination were reported. The ethnic Dutch students interviewed did not socialize much with immigrants, nor did students of both groups learn much from one another. Most students favoured mixed study groups. The diversity of the population does not seem to have caused serious problems, nor has it offered educational benefits. The challenge for educators is to provide systematic education in cultural competence and cross-cultural medicine, in which students and educators indeed practise communication across cultural borders.

Academic Medical Centers↗

PubMed2005

Genetic risk estimation by healthcare professionals.

OBJECTIVES: To assess whether healthcare professionals correctly incorporate the relevance of a favourable test outcome in a close relative when determining the level of risk for individuals at risk for Huntington's disease. DESIGN AND SETTING: Survey of clinical geneticists and genetic counsellors from 12 centres of clinical genetics (United Kingdom, 6; The Netherlands, 4; Italy, 1; Australia, 1) in May-June 2002. Participants were asked to assess risk of specific individuals in 10 pedigrees, three of which required use of Bayes' theorem. PARTICIPANTS: 71 clinical geneticists and 41 other healthcare professionals involved in genetic counselling. MAIN OUTCOME MEASURES: Proportion of respondents correctly assessing risk in the three target pedigrees; proportion of respondents who were confident of their estimate. RESULTS: 50%-64% of respondents (for the three targets separately) did not include the favourable test information and incorrectly estimated the risks as being about equal to the prior risks; 77%-91% of these respondents were "sure" or "completely sure" that their estimations were correct. Twenty of the 112 respondents correctly estimated the risks for all three target pedigrees. CONCLUSIONS: Clinical geneticists and genetic counsellors frequently use prior risks in situations where Bayes' theorem should be applied, leading to overestimations of the risk for an individual.

Australia↗

PubMed2003

Awareness: Monitoring versus remembering what happened.

BACKGROUND: Awareness during anesthesia is foremost assessed with postoperative interviews, which may underestimate its incidence. On-line monitors such as the Bispectral Index and patient response to verbal command are not necessarily commonly used. This study investigated response to command during deep sedation (Bispectral Index 60-70) and the ability of prevailing monitoring techniques to indicate awareness and predict recall. METHODS: The authors systematically assessed the response to command using the isolated forearm technique while monitoring electroencephalographic and hemodynamic variables. Fifty-six elective surgical patients were repeatedly given verbal instructions to squeeze the observer's hand during target-controlled infusion with propofol and alfentanil. After recovery, conscious recall was assessed with a short structured interview. RESULTS: Overall, 1,082 commands were given. No response was observed to 887 (82%) commands, an equivocal response was observed to 56 (5%) commands, and an unequivocal response was observed to 139 (13%) commands. Of the 37 patients (66%) with an unequivocal response to command ("awareness"), nine (25%) reported conscious recall after recovery. Their reports provided valuable insights as to how awareness may be adequately addressed. Hemodynamic variables poorly predicted awareness, whereas parameters derived from the encephalogram, especially the Bispectral Index, were highly significant predictors (P < 0.0001). Electroencephalographic parameters did not discriminate between patients with or without conscious recall, whereas heart rate and responsiveness to command did. CONCLUSIONS: The incidence of awareness is underestimated when conscious recall is taken as evidence. Awareness can be monitored on-line with behavioral and modern neurophysiologic measures. Providing feedback during intra-anesthetic awareness helps patients to cope with a potentially stressful situation.

Adult↗

PubMed2002

Favourable mutation test outcomes for individuals at risk for Huntington disease change the perspectives of first-degree relatives.

In mutation testing for Huntington disease, an autosomal dominant hereditary late-onset disorder, unfavourable test outcomes in at-risk individuals provide important information about other family members at risk. On the other hand, common counselling practice considers favourable outcomes as non-informative for at-risk relatives, except for the offspring of the tested individual. We shall show, however, that favourable outcomes also change the perspectives for the tested individual's first-degree relatives at risk. In the case of a (prospective) parent originally at 50% risk, and with n equalling the number of children or fetuses identified as non-carriers, the probability of being a non-carrier equals 2 (n)/(2 (n)+1) for the at-risk parent, providing that none of the offspring of this parent has been identified as a carrier. Likewise, the probability of being a non-carrier equals (2 (n+1)+1)/(2 (n+1)+2) for the (future) siblings of the tested individual. These changes in probabilities are important for individuals who are considering prenatal or presymptomatic DNA-testing for autosomal dominant hereditary late-onset disorders, such as Huntington disease and hereditary forms of cancer (BRCA1/2, FAP, HNPCC). Consequences can be far reaching in the case of pregnancies, where the risk of miscarriage after a prenatal test is 1%-2%. Parents initially at 50% risk may consider not having a prenatal test in successive pregnancies, knowing that favourable test results in previous pregnancies have considerably reduced their personal risk.

DNA Mutational Analysis↗

PubMed2002

Memory function during propofol and alfentanil anesthesia: predictive value of individual differences.

BACKGROUND: Conscious recall and implicit memory have been shown to depend on hypnotic state as measured by electroencephalographic (EEG) bispectral index (BIS). A third expression of memory (unconscious-controlled memory) was recently observed after moderate to light sedation (BIS, 70-80). The present study investigated memory function during deep sedation (BIS, 60-70). As memory effects are small, the authors studied potential predictors of individual differences in memory performance. METHODS: Memory function and speed of information processing were assessed in 56 outpatients before surgery. During propofol anesthesia supplemented with alfentanil, patients heard a series of words while anesthesia was titrated to BIS, 60-70. In between words, response to command was assessed using the Isolated Forearm Technique. The authors tested memory with a word stem completion task and process dissociation procedure to distinguish explicit from implicit effects. RESULTS: Mean (+/- SD) BIS during word presentation was 64.0 +/- 3. Patients with conscious recall of verbal commands (n = 9) did not recall or recognize presented words. Even so, the process dissociation procedure revealed evidence of memory by a significantly higher hit rate in the inclusion condition (0.26) than in the exclusion condition (0.12). Patients without conscious recall showed no evidence of memory for presented words. Hit scores correlated significantly with scores in the preoperative memory test (r = 0.35). CONCLUSIONS: The authors found evidence of weak explicit memory function during anesthesia titrated to BIS, 60-70. The observations strongly suggest that postoperative memory relates to awareness during anesthesia, but the nature of this relation remains unclear. Memory seems more likely in patients with good preoperative memory performance.

Adult↗