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Henderickx MMEL, Hendriks N, Baard J, Wiseman OJ, Scotland KB, Somani BK, Şener TE, Emiliani E, Dragos LB, Villa L, Talso M, Bin Hamri S, Proietti S, Doizi S, Traxer O, Chew BH, Eisner BH, Monga M, Hsi RS, Stern KL, Leavitt DA, Rivera M, Wollin DA, Borofsky M, Canvasser NE, Ingimarsson JP, El Tayeb MM, Bhojani N, Gadzhiev N, Tailly T, Durutovic O, Nagele U, Skolarikos A, Schout BMA, Beerlage HP, Pelger RCM, Kamphuis GM. The Uniform grading tooL for flexIble ureterorenoscoPes (TULIP-tool): a Delphi consensus project on standardised evaluation of flexible ureterorenoscopes. BJU Int 2023; 131:494-502. [PMID: 36208033 DOI: 10.1111/bju.15916] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop a standardised tool to evaluate flexible ureterorenoscopes (fURS). MATERIALS AND METHODS A three-stage consensus building approach based on the modified Delphi technique was performed under guidance of a steering group. First, scope- and user-related parameters used to evaluate fURS were identified through a systematic scoping review. Then, the main categories and subcategories were defined, and the expert panel was selected. Finally, a two-step modified Delphi consensus project was conducted to firstly obtain consensus on the relevance and exact definition of each (sub)category necessary to evaluate fURS, and secondly on the evaluation method (setting, used tools and unit of outcome) of those (sub)categories. Consensus was reached at a predefined threshold of 80% high agreement. RESULTS The panel consisted of 30 experts in the field of endourology. The first step of the modified Delphi consensus project consisted of two questionnaires with a response rate of 97% (n = 29) for both. Consensus was reached for the relevance and definition of six main categories and 12 subcategories. The second step consisted of three questionnaires (response rate of 90%, 97% and 100%, respectively). Consensus was reached on the method of measurement for all (sub)categories. CONCLUSION This modified Delphi consensus project reached consensus on a standardised grading tool for the evaluation of fURS - The Uniform grading tooL for flexIble ureterorenoscoPes (TULIP) tool. This is a first step in creating uniformity in this field of research to facilitate future comparison of outcomes of the functionality and handling of fURS.
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Affiliation(s)
- Michaël M E L Henderickx
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Nora Hendriks
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Urology, Alrijne Hospital, Leiden, The Netherlands
| | - Joyce Baard
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Oliver J Wiseman
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kymora B Scotland
- Department of Urology, University of California, Los Angeles, CA, USA
| | - Bhaskar K Somani
- Department of Urology, University Hospitals Southampton NHS Trust, Southampton, UK
| | - Tarik E Şener
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Laurian B Dragos
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Luca Villa
- Department of Urology, Università Vita - Salute San Raffaele, Milan, Italy
| | - Michele Talso
- Department of Urology, ASST Fatebenefratelli Sacco - Ospedale Luigi Sacco University Hospital, Milan, Italy
| | - Saeed Bin Hamri
- Department of Urology, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Steeve Doizi
- Department of Urology, Hopital Tenon, Paris, France
- Sorbonne Université, 27063, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Paris, France
| | - Olivier Traxer
- Department of Urology, Hopital Tenon, Paris, France
- Sorbonne Université, 27063, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Paris, France
| | - Ben H Chew
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | - Brian H Eisner
- Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Manoj Monga
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karen L Stern
- Department of Urology, Mayo Clinic, Phoenix, AZ, USA
| | - David A Leavitt
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel A Wollin
- Department of Urology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Noah E Canvasser
- Department of Urology, University of California Davis Health System, Sacramento, CA, USA
| | | | - Marawan M El Tayeb
- Department of Urology, Baylor Scott & White Medical Center - Temple, Temple, TX, USA
| | - Naeem Bhojani
- Department of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | | | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Otas Durutovic
- Department of Urology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Udo Nagele
- Department of Urology, General Hospital Hall I.T., Hall in Tirol, Austria
| | | | | | - Harrie P Beerlage
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Rob C M Pelger
- Department of Urology, Leids UMC, University of Leiden, Leiden, The Netherlands
| | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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Zeelenberg AM, Hendriks N, Schout BMA, van der Spruit JA. Case report. Geschokt door de wachttijd: ESWL bij blaasstenen. Tijdschr Urol 2022. [PMCID: PMC8500464 DOI: 10.1007/s13629-021-00341-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
SamenvattingDe behandeling van eerste keuze voor vesicale stenen is de transurethrale cystolithotripsie (TUCL). Door de COVID-19-pandemie kampen ziekenhuizen echter met lange wachttijden voor – onder meer – deze operaties. Daarnaast komen sommige patiënten niet in aanmerking voor een operatie door hun comorbiditeit. In de jaren negentig van de vorige eeuw was extracorporele shockwave lithotripsie (ESWL) een veel gebruikte, veilige behandelmethode voor blaasstenen. Toen TUCL effectiever bleek, is ESWL voor blaasstenen echter in de vergetelheid geraakt. ESWL is poliklinisch uit te voeren, waardoor wachttijden korter zijn dan die voor operatieve ingrepen. Gedurende de COVID-19-pandemie hebben we enkele patiënten met blaasstenen behandeld met ESWL. We concluderen dat ESWL een geschikt alternatief is voor de TUCL bij geselecteerde patiënten, maar dat voor een effectieve behandeling meerdere ESWL-procedures nodig zijn.
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Hendriks N, Henderickx MMEL, Schout BMA, Baard J, van Etten-Jamaludin FS, Beerlage HP, Pelger RCM, Kamphuis GM. How to evaluate a flexible ureterorenoscope? Systematic mapping of existing evaluation methods. BJU Int 2021; 128:408-423. [PMID: 34242475 PMCID: PMC8519042 DOI: 10.1111/bju.15544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/25/2021] [Accepted: 07/02/2021] [Indexed: 01/01/2023]
Abstract
Objectives The objective of this study was to identify, map and review scope‐related and user‐related parameters used to evaluate the quality of flexible ureterorenoscopes. Thereby identifying key items and variability in grading systems. Methods A literature search of four databases (MEDLINE [Ovid], EMBASE [Ovid], Web of Science, Google scholar and the Cochrane Library) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines encompassing articles published up to August 2020. A total of 2386 articles were screened. Results A total of 48 articles were included in this systematic scoping review. All studies had a prospective design. Five key items in the assessment of flexible ureterorenoscopy were distinguished: ‘Manoeuvrability’ (87.5%), ‘Optics’ (64.6%), ‘Irrigation’ (56.3%), ‘Handling’ (39.6%) and ‘Durability’ (35.4%). After regrouping, every key item could be divided into specific subcategories. However, the quality assessment showed a wide variation in denomination, method of measurement, circumstances of measurement, tools used during measurements, number of measurements performed, number of observers, and units of outcomes. Conclusion The research field regarding quality assessment of ureterorenoscopes is heterogeneous. In this systematic scoping review we identified five key parameters: Manoeuvrability, Optics, Irrigation, Handling and Durability, used to grade flexible ureterorenoscopes. However, within these categories we found a wide variety in terms of method of measurements. A standardised, uniform grading tool is required to assess and compare the quality of flexible ureterorenoscopes in the future.
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Affiliation(s)
- Nora Hendriks
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Urology, Alrijne Hospital, Leiderdorp, the Netherlands
| | - Michaël M E L Henderickx
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Urology, GZA Hospitals, Antwerp, Belgium
| | | | - Joyce Baard
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Faridi S van Etten-Jamaludin
- Research Support, Medical library location AMC, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Harrie P Beerlage
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Rob C M Pelger
- Department of Urology, Leids UMC, University of Leiden, Leiden, the Netherlands
| | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Weltings S, Buddingh KT, van Diepen DC, Pelger RCM, Putter H, Rad M, Schout BMA, Roshani H. The BUSCOPAN study: a randomized-controlled non-inferiority trial of a continuous butylscopolamine infusion versus placebo in patients with a renal colic not responding to oral non-steroidal anti-inflammatory drugs. World J Urol 2020; 39:2747-2752. [PMID: 32949255 PMCID: PMC8332573 DOI: 10.1007/s00345-020-03460-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/10/2020] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To investigate whether placebo is non-inferior to continuous infusion of butylscopolamine in patients with renal colic. METHODS We conducted a placebo-controlled, multicenter, double-blind randomized clinical trial (RCT) including 128 patients with renal colic (confirmed by ultrasound or CT-scan). Patients were randomized to receive either continuous IV butylscopolamine 100 mg/24 h or placebo (saline). Primary outcome is the amount of opioid escape medication used, measured in doses administered. Secondary outcomes are pain measured on a Numeric Rating Scale (NRS), side effects, and time of drug administration. Non-inferiority was assessed using linear regression with robust standard errors, with non-inferiority limit set at 0.5 units of escape medication. RESULTS Median number of doses of escape medication was one in both groups. The number of extra doses in the placebo group compared with the butylscopolamine group was 0.05, with a 95% robust confidence interval (CI) of 0.38-0.47. Upper limit of the CI remained below the non-inferiority limit of 0.5 (p = 0.04). No differences in secondary endpoints were seen between the groups. CONCLUSION Placebo is non-inferior to continuous IV butylscopolamine for pain relief in patients with renal colic. Based on this study and previous evidence, there is no role for continuous butylscopolamine IV in the treatment of renal colic. Trial NL7819.
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Affiliation(s)
- S Weltings
- Haga Teaching Hospital, The Hague, The Netherlands.
| | - K T Buddingh
- Haga Teaching Hospital, The Hague, The Netherlands
| | | | | | | | - M Rad
- Haga Teaching Hospital, The Hague, The Netherlands
| | - B M A Schout
- Alrijne Health Group, Leiderdorp, The Netherlands
| | - H Roshani
- Haga Teaching Hospital, The Hague, The Netherlands
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5
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Jacobs JBM, Weltings S, Pelger RCM, Schout BMA. Patient reported outcome measures (PROMs) and patient reported experience measures (PREMs) for Dutch urolithiasis patients. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s13629-019-00278-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
AbstractMeasuring quality of care with Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) is becoming increasingly important. With this study we evaluated ESWL and URS treatments with PROMs/PREMs and gained experience with the execution and implementation of PROMs/PREMs in daily practice. A longitudinal survey study was performed with ESWL and URS urolithiasis patients, using a questionnaire directly (T0-response 69.8%, n = 51) and 10 days after treatment (T1-response 56%, n = 42). Problems on performing daily activities were experienced by 54.2% of ESWL and 61.1% of URS-patients. In the two weeks after treatment 45.8% of the ESWL group and 70.6% of the URS-patients uses pain medication. URS-patients miss more workdays (5.61 versus 1.26 p = 0.025). Patient satisfaction is similar in both groups. With this study we have made a start with PROMs and PREMs for urolithiasis patients. It shows that urolithiasis treatment has influence on patient’s life. More knowledge in this area will improve shared decision making.
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de Vries AH, Muijtjens AMM, van Genugten HGJ, Hendrikx AJM, Koldewijn EL, Schout BMA, van der Vleuten CPM, Wagner C, Tjiam IM, van Merriënboer JJG. Development and validation of the TOCO–TURBT tool: a summative assessment tool that measures surgical competency in transurethral resection of bladder tumour. Surg Endosc 2018; 32:4923-4931. [DOI: 10.1007/s00464-018-6251-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
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de Vries AH, Schout BMA, van Merriënboer JJG, Pelger RCM, Koldewijn EL, Muijtjens AMM, Wagner C. High educational impact of a national simulation-based urological curriculum including technical and non-technical skills. Surg Endosc 2016; 31:928-936. [PMID: 27387182 DOI: 10.1007/s00464-016-5060-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 06/16/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although simulation training is increasingly used to meet modern technology and patient safety demands, its successful integration within surgical curricula is still rare. The Dutch Urological Practical Skills (D-UPS) curriculum provides modular simulation-based training of technical and non-technical basic urological skills in the local hospital setting. This study aims to assess the educational impact of implementing the D-UPS curriculum in the Netherlands and to provide focus points for improvement of the D-UPS curriculum according to the participants. METHODS Educational impact was assessed by means of qualitative individual module-specific feedback and a quantitative cross-sectional survey among residents and supervisors. Twenty out of 26 Dutch teaching hospitals participated. The survey focussed on practical aspects, the D-UPS curriculum in general, and the impact of the D-UPS curriculum on the development of technical and non-technical skills. RESULTS A considerable survey response of 95 % for residents and 76 % for supervisors was obtained. Modules were attended by junior and senior residents, supervised by a urologist, and peer teaching was used. Ninety percent of supervisors versus 67 % of residents judged the D-UPS curriculum as an important addition to current residency training (p = 0.007). Participants' aggregated general judgement of the modules showed a substantial percentage favorable score (M ± SE: 57 ± 4 %). The impact of training on, e.g., knowledge of materials/equipment and ability to anticipate on complications was high, especially for junior residents (77 ± 5 and 71 ± 7 %, respectively). Focus points for improvement of the D-UPS curriculum according to the participants include adaptation of the training level to residents' level of experience and focus on logistics. CONCLUSION The simulation-based D-UPS curriculum has a high educational impact. Residents and supervisors consider the curriculum to be an important addition to current residency training. Focus points for improvement of the D-UPS curriculum according to the participants include increased attention to logistics and integration of a spiral learning approach.
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Affiliation(s)
- Anna H de Vries
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Barbara M A Schout
- Department of Urology, Alrijne Hospital, Leiden, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | - Rob C M Pelger
- Department of Urology, University Medical Center Leiden, Leiden, The Netherlands
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.,School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Arno M M Muijtjens
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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de Vries AH, Lesterhuis E, Verweij LM, Schout BMA, van der Horst HJR, Leppink J, Koldewijn EL, Wagner C. High level of patient satisfaction and comfort during diagnostic urological procedures performed by urologists and residents. Scand J Urol 2015; 50:206-11. [PMID: 26635064 DOI: 10.3109/21681805.2015.1116109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to investigate how patients experience diagnostic urological procedures performed by urologists, junior residents and senior residents, and to assess the influence of procedure-related factors on patient experiences. METHODS Data were collected during 222 procedures: 84 transrectal ultrasound-guided prostate biopsies (TRUSP; urologists n = 39, residents n = 45) and 138 urethrocystoscopies (UCS; urologists n = 44, residents n = 94) in six hospitals. Patient experiences were assessed using a questionnaire focusing on pain, comfort and satisfaction (visual analogue scale, 0-10) and communication aspects on a four-point Likert scale. Clinical observations were made to identify influencing factors. RESULTS Median values for patient experiences across procedures were 10 (range 5-10) for patient satisfaction, 2 (0-9) for pain and 8 (0-10) for comfort. Generalized estimating equations revealed no significant differences between urologists, senior residents and junior residents in terms of experienced patient comfort, satisfaction or pain. Procedural time was longer for residents, but this did not correlate significantly with patient-experienced comfort (p = 0.3). In UCS, patient comfort and satisfaction were higher in the supine position for male and female patients, respectively (p < 0.01). In TRUSP, local anaesthesia resulted in a significant decrease in pain (p = 0.002) and an increase in comfort (p = 0.03). Finally, older patients experienced less pain and gave higher comfort and satisfaction responses than younger patients. CONCLUSIONS Patients expressed high levels of satisfaction and comfort during diagnostic urological procedures. Experiences were not affected by the level of training, suggesting highly developed interpersonal and communication skills for residents in an early stage of residency training. Patients demonstrated significant preferences for local anaesthesia in TRUSP and performance of UCS in the supine position over the lithotomy position.
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Affiliation(s)
- A H de Vries
- a Department of Urology , Catharina Hospital , Eindhoven , The Netherlands
| | - E Lesterhuis
- b Department of Urology , Westfriesgasthuis , Hoorn , The Netherlands
| | - L M Verweij
- c Netherlands Institute for Health Services Research (NIVEL) , Utrecht , The Netherlands
| | - B M A Schout
- c Netherlands Institute for Health Services Research (NIVEL) , Utrecht , The Netherlands ;,d Department of Urology , Alrijne Hospital , Leiden , The Netherlands
| | | | - J Leppink
- f Department of Educational Development and Research , School of Health Professions Education, Maastricht University , Maastricht , The Netherlands
| | - E L Koldewijn
- a Department of Urology , Catharina Hospital , Eindhoven , The Netherlands ;,g Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , The Netherlands
| | - C Wagner
- c Netherlands Institute for Health Services Research (NIVEL) , Utrecht , The Netherlands ;,h Department of Public and Occupational Health , EMGO Institute for Health and Care Research , Amsterdam , The Netherlands
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de Vries AH, van Luijk SJ, Scherpbier AJJA, Hendrikx AJM, Koldewijn EL, Wagner C, Schout BMA. High acceptability of a newly developed urological practical skills training program. BMC Urol 2015; 15:93. [PMID: 26337054 PMCID: PMC4560076 DOI: 10.1186/s12894-015-0084-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/19/2015] [Indexed: 11/11/2022] Open
Abstract
Background Benefits of simulation training are widely recognized, but its structural implementation into urological curricula remains challenging. This study aims to gain insight into current and ideal urological practical skills training and presents the outline of a newly developed skills training program, including an assessment of the design characteristics that may increase its acceptability. Methods A questionnaire was sent to the urology residents (n = 87) and program directors (n = 45) of all Dutch teaching hospitals. Open- and close-ended questions were used to determine the views on current and ideal skills training and the newly developed skills training program. Eight semi-structured interviews were conducted with 39 residents and 15 program directors. All interviews were audiotaped, fully transcribed, and thereafter analyzed. Results Response was 87.4 % for residents and 86.7 % for program directors. Residents appeared to be still predominantly trained ‘by doing’. Structured practical skills training in local hospitals takes place according to 12 % of the residents versus 44 % of the program directors (p < 0.001). Ideally, residents prefer to practice certain procedures on simulation models first, especially in endourology. The majority of residents (92 %) and program directors (87 %) approved of implementing the newly developed skills training program (p = 0.51). ‘Structured scheduling’, ‘use of peer teaching’ and ‘high fidelity models’ were indicated as design characteristics that increase its acceptability. Conclusions Current urological residency training consists of patient-related ‘learning by doing’, although more practice on simulation models is desired. The acceptability of implementing the presented skills-training program is high. Design characteristics that increase its acceptability are structured scheduling, the use of peer teaching and high fidelity models. Electronic supplementary material The online version of this article (doi:10.1186/s12894-015-0084-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna H de Vries
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.
| | - Scheltus J van Luijk
- Academy of Post-graduate Education, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Albert J J A Scherpbier
- Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Ad J M Hendrikx
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands. .,Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Cordula Wagner
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. .,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
| | - Barbara M A Schout
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. .,Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands.
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10
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de Vries AH, Boute MC, Kuppen MCP, van Merriënboer JJG, Koldewijn EL, Pelger RCM, Schout BMA, Wagner C. Patient Safety Risks of Basic Urological Procedures Performed by Junior and Senior Residents. J Surg Educ 2015; 72:918-926. [PMID: 26117078 DOI: 10.1016/j.jsurg.2015.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/18/2015] [Accepted: 04/16/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the current performance of urological residents regarding basic urological procedures in relation to patient safety issues and the identification of specific training needs. DESIGN Observational data of 146 urethrocystoscopies (UCSs), 27 transrectal ultrasounds of the prostate (TRUSs), 38 transrectal ultrasound-guided prostatic biopsies (TRUSPs), and 30 transurethral resections of bladder tumor (TURBTs) were collected. Performance was evaluated using scoring lists including details on completeness of procedural steps, level of independence, time, and the incidence of unintended events. The causal factors contributing to the unintended events were identified by 2 expert urologists and classified according to the recognized PRISMA method. SETTING This study was performed in 5 teaching hospitals in the Netherlands. PARTICIPANTS We included 11 junior residents and 5 senior residents in urology in the final study cohort. RESULTS Senior residents showed a lower degree of completeness in material usage than junior residents did during UCS (p < 0.01) and in preparation, material usage, and procedure during TRUSP (all p < 0.05). In UCS and TURBT, senior residents received significantly less feedback than junior residents did (both p < 0.01). Incidence of unintended events for junior vs senior residents was 11% and 4% in UCS, 0% and 7% in transrectal ultrasound of the prostate, 36% and 62% in TRUSP, and 41% and 23% in TURBT, respectively. Overall, unintended events were mainly caused by human factors, in particular, verification and skills-based issues. CONCLUSION Present performance of basic urological procedures involves a high percentage of unintended events, especially in TRUSP and TURBT, which are mainly caused by human factors and are a potential threat for patient safety. Junior residents are less independent but more thorough in the performance of UCS and TRUSP than senior residents are. Targeted skills training including assessment should be implemented before privileges for independent practice are granted to reduce the incidence of unintended events and optimize patient safety.
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Affiliation(s)
- Anna H de Vries
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.
| | - Maaike C Boute
- Department of Surgery, Westfriesgasthuis, Hoorn, The Netherlands
| | - Malou C P Kuppen
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jeroen J G van Merriënboer
- Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands; Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rob C M Pelger
- Department of Urology, University Medical Center Leiden, Leiden, The Netherlands
| | - Barbara M A Schout
- Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands; Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands; Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Brinkman WM, Luursema JM, Kengen B, Schout BMA, Witjes JA, Bekkers RL. da Vinci skills simulator for assessing learning curve and criterion-based training of robotic basic skills. Urology 2013; 81:562-6. [PMID: 23295136 DOI: 10.1016/j.urology.2012.10.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/04/2012] [Accepted: 10/12/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To answer 2 research questions: what are the learning curve patterns of novices on the da Vinci skills simulator parameters and what parameters are appropriate for criterion-based robotic training. MATERIALS AND METHODS A total of 17 novices completed 2 simulator sessions within 3 days. Each training session consisted of a warming-up exercise, followed by 5 repetitions of the "ring and rail II" task. Expert participants (n = 3) performed a warming-up exercise and 3 repetitions of the "ring and rail II" task on 1 day. We analyzed all 9 parameters of the simulator. RESULTS Significant learning occurred on 5 parameters: overall score, time to complete, instrument collision, instruments out of view, and critical errors within 1-10 repetitions (P <.05). Economy of motion and excessive instrument force only showed improvement within the first 5 repetitions. No significant learning on the parameter drops and master workspace range was found. Using the expert overall performance score (n = 3) as a criterion (overall score 90%), 9 of 17 novice participants met the criterion within 10 repetitions. CONCLUSION Most parameters showed that basic robotic skills are learned relatively quickly using the da Vinci skills simulator, but that 10 repetitions were not sufficient for most novices to reach an expert level. Some parameters seemed inappropriate for expert-based criterion training because either no learning occurred or the novice performance was equal to expert performance.
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Affiliation(s)
- Willem M Brinkman
- Department of Urology, Catharina Hospital Eindhoven, The Netherlands.
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12
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Tjiam IM, Schout BMA, Hendrikx AJ, Muijtjens AM, Scherpbier AJ, Witjes JA, Van Der Vleuten CP. Program for laparoscopic urological skills assessment: Setting certification standards for residents. MINIM INVASIV THER 2012; 22:26-32. [DOI: 10.3109/13645706.2012.686918] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Tjiam IM, Schout BMA, Hendrikx AJM, Scherpbier AJJM, Witjes JA, van Merriënboer JJG. Designing simulator-based training: an approach integrating cognitive task analysis and four-component instructional design. Med Teach 2012; 34:e698-e707. [PMID: 23088360 DOI: 10.3109/0142159x.2012.687480] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Most studies of simulator-based surgical skills training have focused on the acquisition of psychomotor skills, but surgical procedures are complex tasks requiring both psychomotor and cognitive skills. As skills training is modelled on expert performance consisting partly of unconscious automatic processes that experts are not always able to explicate, simulator developers should collaborate with educational experts and physicians in developing efficient and effective training programmes. This article presents an approach to designing simulator-based skill training comprising cognitive task analysis integrated with instructional design according to the four-component/instructional design model. This theory-driven approach is illustrated by a description of how it was used in the development of simulator-based training for the nephrostomy procedure.
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Affiliation(s)
- Irene M Tjiam
- Department of Urology, Catharina Hospital Eindhoven, The Netherlands.
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Schout BMA, Meuleman EJH. [Erectile dysfunction and incontinence after prostatectomy. Treating the complications of surgery for prostate cancer]. Ned Tijdschr Geneeskd 2012; 156:A4667. [PMID: 23114170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
After having undergone a radical prostatectomy, 1 out of 5 men is dissatisfied about the functional results particularly because of complications like erectile dysfunction and urinary incontinence; these complications frequently do occur. During the first postoperative year, patient counselling and guidance are necessary aspects of the management of urinary incontinence and erectile dysfunction. In order to prevent irreversible erectile dysfunction, it is important that the patient resumes sexual activity soon after the operation; if necessary, a phosphodiesterase-5 (PDE-5) inhibitor or intracavernosal injection therapy may be used. Treatment of urinary incontinence in the first postoperative year consists of pelvic floor exercises and guidance on the use of collection devices, penile clamps or condom catheters. If urogenital functional disorders persist after one year, in a way that significantly affects patient's quality of life, the implantation of an erectile prosthesis or - depending on the amount of urine loss - a sling or sphincter prosthesis is indicated.
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Schout BMA, Hendrikx AJM, Scheele F, Bemelmans BLH, Scherpbier AJJA. Validation and implementation of surgical simulators: a critical review of present, past, and future. Surg Endosc 2009; 24:536-46. [PMID: 19633886 PMCID: PMC2821618 DOI: 10.1007/s00464-009-0634-9] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Revised: 05/31/2009] [Accepted: 06/26/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the past 20 years the surgical simulator market has seen substantial growth. Simulators are useful for teaching surgical skills effectively and with minimal harm and discomfort to patients. Before a simulator can be integrated into an educational program, it is recommended that its validity be determined. This study aims to provide a critical review of the literature and the main experiences and efforts relating to the validation of simulators during the last two decades. METHODS Subjective and objective validity studies between 1980 and 2008 were identified by searches in Pubmed, Cochrane, and Web of Science. RESULTS Although several papers have described definitions of various subjective types of validity, the literature does not offer any general guidelines concerning methods, settings, and data interpretation. Objective validation studies on endourological simulators were mainly characterized by a large variety of methods and parameters used to assess validity and in the definition and identification of expert and novice levels of performance. CONCLUSION Validity research is hampered by a paucity of widely accepted definitions and measurement methods of validity. It would be helpful to those considering the use of simulators in training programs if there were consensus on guidelines for validating surgical simulators and the development of training programs. Before undertaking a study to validate a simulator, researchers would be well advised to conduct a training needs analysis (TNA) to evaluate the existing need for training and to determine program requirements in a training program design (TPD), methods that are also used by designers of military simulation programs. Development and validation of training models should be based on a multidisciplinary approach involving specialists (teachers), residents (learners), educationalists (teaching the teachers), and industrial designers (providers of teaching facilities). In addition to technical skills, attention should be paid to contextual, interpersonal, and task-related factors.
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Affiliation(s)
- B M A Schout
- Department of Urology, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands.
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Schout BMA, Bemelmans BLH, Martens EJ, Scherpbier AJJA, Hendrikx AJM. How useful and realistic is the uro trainer for training transurethral prostate and bladder tumor resection procedures? J Urol 2009; 181:1297-303; discussion 1303. [PMID: 19152928 DOI: 10.1016/j.juro.2008.10.169] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Indexed: 11/15/2022]
Abstract
PURPOSE We evaluated the face and content validity (novice and expert opinions of realism and usefulness) of the Uro Trainer (Karl Storz GmbH, Tuttlingen, Germany), a simulator for transurethral resection procedures, to ascertain whether it is justifiable to continue the validation process by performing prospective experimental studies. MATERIALS AND METHODS Between 2006 and 2008, 104 urologists and urology residents performed a transurethral bladder tumor resection and/or transurethral prostate resection procedure on the Uro Trainer, and rated simulator usefulness and realism on a 10-point scale (1-not at all useful/realistic/poor, 10-very useful/realistic/excellent). Participants were classified as experts (more than 50 procedures performed) or novices (50 or fewer procedures performed). Because the literature offered no guidelines for interpreting our data, we used criteria from other studies to interpret the results. RESULTS A total of 161 questionnaires were analyzed from 97 (21% experts, 79% novices) and 64 (30% experts, 70% novices) participants who performed transurethral prostate resection and transurethral bladder tumor resection procedures, respectively. Mean usefulness, realism and overall scores varied from 5.6 to 8.2 (SD 1.4-2.5). Measured by validity criteria from other studies, Uro Trainer face and content validity was unsatisfactory, with ratings on only 3%, 5% and 8% of the parameters interpreted as positive, moderately acceptable and good, respectively. CONCLUSIONS Measured against criteria from other validation studies, Uro Trainer face and content validity appears to be unsatisfactory. Modification of the simulator seems advisable before further experimental validation studies are initiated. The lack of general guidelines for establishing face and content validity suggests a need for consensus about appropriate methods for evaluating the validity of simulators.
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Affiliation(s)
- Barbara M A Schout
- Department of Urology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Schout BMA, Dolmans VEMG, Hendrikx AJM, Brouwer T, Scherpbier AJJA, Schijven MP, Bemelmans BLH. Is endoscopic-skills training in a skills laboratory necessary? Perceptions of urology programme directors in the Netherlands. BJU Int 2008; 102:1362-3. [PMID: 18715249 DOI: 10.1111/j.1464-410x.2008.07906.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara M A Schout
- Department of Urology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands.
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Schout BMA, Hendrikx AJM, Scherpbier AJJA, Bemelmans BLH. Update on training models in endourology: a qualitative systematic review of the literature between January 1980 and April 2008. Eur Urol 2008; 54:1247-61. [PMID: 18597924 DOI: 10.1016/j.eururo.2008.06.036] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 06/12/2008] [Indexed: 01/06/2023]
Abstract
CONTEXT Interest in the use of simulators in urological skills training is on the increase. To ensure effective implementation of training models, an overview of the nature and validity of the available models is of the essence. OBJECTIVE To obtain an overview of training models and their validity by performing a qualitative systematic review of the literature. EVIDENCE ACQUISITION Studies were identified through searches of PubMed, the Cochrane Library, and Web of Science between January 1980 and April 2008 using two search strategies: "urology and (training or simulat or model)" and combinations of these terms with "prostate," "kidney," "bladder," or "ureter." Studies were included if they (1) described one or more training models, and/or (2) examined the validity of training models. Studies in undergraduate education and of training models for physical examination were excluded. Validation studies were scored according to Kirkpatrick and Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence. EVIDENCE SYNTHESIS Forty-five articles (out of the initial list of 4753 retrieved articles, 0.9%) were included, describing 30 types of training models and 54 validation studies. The largest number of models has been described for ureterorenoscopy (nine types). Only three randomised controlled trials (RCTs), receiving a 1b OCEBM level of evidence score, were found. Studies investigating the impact of simulator training on performance in patients (criterion B validity) were scarce. The number of participants in experimental studies ranged from 7 to 136. CONCLUSIONS Due to growing interest in training models in urology, it is increasingly urgent to determine which of these models are most valuable for postgraduate training. Because the validation studies published so far are few in number, have low evidence levels, and are composed of only a few RCTs, it is important that more randomised controlled validation studies including larger numbers of participants are performed.
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Affiliation(s)
- Barbara M A Schout
- Catharina Hospital Eindhoven, Eindhoven, The Netherlands; VU Medical Centre Amsterdam, Amsterdam, The Netherlands.
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Schijven MP, Schout BMA, Dolmans VEMG, Hendrikx AJM, Broeders IAMJ, Borel Rinkes IHM. Perceptions of surgical specialists in general surgery, orthopaedic surgery, urology and gynaecology on teaching endoscopic surgery in The Netherlands. Surg Endosc 2007; 22:472-82. [PMID: 17762954 PMCID: PMC2234445 DOI: 10.1007/s00464-007-9491-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2007] [Revised: 05/28/2007] [Accepted: 06/13/2007] [Indexed: 01/29/2023]
Abstract
BACKGROUND Specific training in endoscopic skills and procedures has become a necessity for profession with embedded endoscopic techniques in their surgical palette. Previous research indicates endoscopic skills training to be inadequate, both from subjective (resident interviews) and objective (skills measurement) viewpoint. Surprisingly, possible shortcomings in endoscopic resident education have never been measured from the perspective of those individuals responsible for resident training, e.g. the program directors. Therefore, a nation-wide survey was conducted to inventory current endoscopic training initiatives and its possible shortcomings among all program directors of the surgical specialties in the Netherlands. METHODS Program directors for general surgery, orthopaedic surgery, gynaecology and urology were surveyed using a validated 25-item questionnaire. RESULTS A total of 113 program directors responded (79%). The respective response percentages were 73.6% for general surgeons, 75% for orthopaedic surgeon, 90.9% for urologists and 68.2% for gynaecologists. According to the findings, 35% of general surgeons were concerned about whether residents are properly skilled endoscopically upon completion of training. Among the respondents, 34.6% were unaware of endoscopic training initiatives. The general and orthopaedic surgeons who were aware of these initiatives estimated the number of training hours to be satisfactory, whereas the urologists and gynaecologists estimated training time to be unsatisfactory. Type and duration of endoscopic skill training appears to be heterogeneous, both within and between the specialties. Program directors all perceive virtual reality simulation to be a highly effective training method, and a multimodality training approach to be key. Respondents agree that endoscopic skills education should ideally be coordinated according to national consensus and guidelines. CONCLUSIONS A delicate balance exists between training hours and clinical working hours during residency. Primarily, a re-allocation of available training hours, aimed at core-endoscopic basic and advanced procedures, tailored to the needs of the resident and his or her phase of training is in place. The professions need to define which basic and advanced endoscopic procedures are to be trained, by whom, and by what outcome standards. According to the majority of program directors, virtual reality (VR) training needs to be integrated in procedural endoscopic training courses.
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Affiliation(s)
- M P Schijven
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, PO box 85500, 3508, GA, Utrecht, the Netherlands.
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