[The ears on the vessel of medicine: Jan van Beverwijck's collection of opinions on medicine in antiquity]. / De oren aan het vat van de medische kennis.

Johan van Beverwijck (1595-1647) is known as the author of two Dutch books in which he made medical knowledge accessible to laymen who did not have command of the Latin language. The Dordrecht doctor was open to the many new insights that arose in his time and shook the foundations of the ancient humoural stronghold of Aristotle, Hippocrates and Galen. A nearly forgotten book, Idea veterum medicinae (Opinions on medicine in antiquity), was recently translated into Dutch by the author of this article. It shows that Van Beverwijck remained a true humanist, who loved the ancient world and its culture. The book consists of an extensive compilation of comments by ancient philosophers, poets and historians on health and health care. Van Beverwijck believed his book would provide the tired practitioner with some distraction and might help the medical student to memorise his subject material. Moreover, he believed that some knowledge of the ancient world would deepen medical thinking.

[How can gentlemen of standing grow old healthily? Plemp and his De togatorum valetudine tuenda commentatio (1670)]. / Hoe worden heren van stand gezond oud?

In 1670, the Professor of Medicine V.F. Plemp from the Belgian University of Leuven published a book explaining in an entertaining fashion how elderly gentlemen in positions of authority could live for a long time in good health but still have enjoyable lives. In writing this book the author manifested himself as a 17th century forerunner of the modern fitness and wellness movement. Plemp was a humanist who believed in the renaissance of Antiquity, and his medical revelations originate largely from ancient Roman sources. He also skilfully intertwined his health advice with descriptions of Greek and Roman customs and mores.

Ultrasonographic screening for developmental dysplasia of the hip in infants. Reproducibility of assessments made by radiographers.

We studied the reproducibility of ultrasonographic screening examination of the hip when read by diagnostic radiographers. In order to determine interobserver variability, 200 ultrasonograms were classified according to Graf's method by five observers (four radiographers and one radiologist). The kappa values for interobserver variability indicated moderate agreement (kappa 0.47) for the exact Graf classification and substantial agreement (kappa 0.65) for the classification of normal (type I) versus abnormal (type IIa-IV). Agreement was significantly different for normal, immature and abnormal hips. Comparison of the findings in our interobserver study with existing information based on other examinations and treatment revealed that only a small number of infants with mildly dysplastic hips would have been typed as normal by some observers as a result of observer variability. In conclusion, the interobserver agreement on the ultrasound assessment of the hip was good enough for screening purposes. Observer variability did not result in any severe cases being missed.

['Advanced triage' improves patient flow in the emergency department without affecting the quality of care]. / 'Advanced triage' geeft snellere patiëntdoorstroming SEH, zonder verlies aan kwaliteit van zorg.

OBJECTIVE: To investigate whether 'advanced triage' improved patient flow among self-referred patients in the emergency department of a level 1 trauma centre and, most importantly, whether the quality of medical care was maintained. In advanced triage, the triage nurse initiates additional diagnostic investigations independently. DESIGN: Interventional study. METHODS: After a baseline measurement had been carried out for eleven days (n = 506), the advanced triage protocol was tested during ten day or evening shifts (n = 198). The length of stay in the emergency department was measured. The attending emergency physician assessed the correctness and completeness of the additional diagnostics initiated by the triage nurse. Two traumatologists and two radiologists assessed the quality of x-ray imaging requests independently of each other. RESULTS: Average patient length of stay (LOS) was reduced by fourteen minutes (14%). The improvement was achieved primarily in patients who required additional diagnostic investigations. Their average LOS decreased by 27 minutes (18%). There was an 8% increase in the total number of diagnostic investigations requested. The triage nurse initiated the investigations correctly and fully in 93% of cases. The quality of x-ray imaging requests remained the same as before the introduction of advanced triage. CONCLUSION: The implementation of advanced triage improved patient flow for self-referred patients in the emergency department without affecting the quality of medical care. Advanced triage was successful in the Dutch system, too.