A COMMENT FROM THE COORDINATOR
A special thank you to Gatien de Broucker, Michael Head and Rebecca Brown for their presentations given during the “The Fight Against Pneumonia: Who Pays?” webinar event on June 27, 2018.
DEEP BREATHS: BLOGS FROM PIN MEMBERS
St. John the Baptist in the Wilderness: the art and science of clinical observations
by Ger T. Rijkers 1,2,3*
1 Department of Sciences, University College Roosevelt, Middelburg
2 Laboratory for Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, The Netherlands
3 Co-Editor in chief, Pneumonia.
At a liberal arts and sciences college such as University College Roosevelt, biomedical professors and researchers are not only surrounded by colleagues from closely related fields such as biology, chemistry and statistics, but also by (art) historians, philosophers, sociologists, and other representatives from the complete academic spectrum. This makes it sometimes more difficult to explain the relevance of your own work, but it always forms a great source of inspiration and discussions which can take an unpredictable course. As an example: how to interpret an image?
In pneumonia, an important step on the path to reach a clinical diagnosis is the correct interpretation of the image of the lung, be it a conventional x-ray or more innovative imaging techniques. What you see is what you get, and therefore, it is crucial to know what you see. In the medical sciences this may sometimes be difficult, but the same holds true for the arts.
In the painting “Saint John the Baptist in the Wilderness” by Jheronimus Bosch (Figure 1, panel a), Saint John himself in his red robe is depicted like a centerfold avant-la-lettre. His right index finger is pointing towards a lamb, an obvious link to his biblical role of baptizing Jesus Christ. Closer observation reveals a plethora of animals and strange creatures in the background landscape. Their role is unclear as it is also unknown whether these details are needed for correct interpretation. When using an alternative imaging technique to the human eye, namely infrared reflectography, a different image shows up. Standing next to Saint John is the figure of a donor, apparently hidden by Bosch in the final version of the painting. During those days, the donor who commissioned the work, and also paid for it, demanded to be included in the scene. When a donor changed his mind, or died before the painting and the deal were completed, the painter faced a problem. The usual solution was to hide the donor, in this case by painting some bushes on top of him. The full and correct interpretation of the image therefore, requires innovative techniques. Interpretation both of medical as well as artistic images can be difficult. In up to 60% of cases of pneumonia, the specific cause remains unknown and unseen. Should we look better or differently? Observation is critical because what you don’t see, you can’t treat. Take your time and use different angles.
Have you become interested in Jheronimus Bosch’s meaning for the medical sciences? Search for titles of his other paintings on PubMed.
Figure 1: Saint John the Baptist in the Wilderness by Jheronimus Bosch, dated around 1489 (Museum of Lázaro Galdiano, Madrid, Spain). Panel a shows Saint John dressed in his red robe, pointing his right index finger at a lamb. The infrared reflectogram (b) reveals the (unknown) donor.
(Wikimedia Commons: Jheroniumus Bosch, Paintings) https://commons.wikimedia.org/wiki/Category:Saint_John_the_Baptist_by_Hieronymus_Bosch
PNEUMONIA INNOVATIONS NETWORK MEMBER AND PARTNER UPDATES
PIN members publish paper, “Adoption of paediatric and neonatal pulse oximetry by 12 hospitals in Nigeria: a mixed-methods realist evaluation.”
This paper by Hamish R Graham, Ayobami A Bakare, Amy Gray, Adejumoke Idowu Ayede, Shamim Qazi, Barbara McPake, Rasa Izadnegahdar, Trevor Duke, and Adegoke G Falade was recently published in BMJ Global Health. Congratulations to PIN members and colleagues who have published their work on oxygen in Nigeria! Read the article here.
Dr. Hamish Graham shares some of the key takeaways of their mixed-methods realist evaluation:
- Pulse oximetry can be rapidly adopted by nurses, and become part of routine vital signs practices (most hospitals reached >90% coverage of admitted children and neonates within 3-6 months).
- However, while pulse oximetry is a relatively simple practice, adoption into routine practice requires individual and institutional behavioral and structural changes.
- Successful pulse oximetry adoption is more about motivation than knowledge/skills. Pulse oximetry may be easy to use, but need to convince users why they should do it.
- The key motivators for pulse oximetry practice hinge on users recognising some kind of benefit. This is not only the technical benefit (helping identify hypoxaemia, guide oxygen therapy), but also the broader clinical benefits (saving lives, better monitoring of sick patients etc.) and practical benefits (saves time doing vital signs, gives nurses greater confidence, builds trust with patients etc.).
- Supportive management strategies are critical to support users as they begin to use pulse oximeters, including practical help to troubleshoot problems and encouragement to keep trying (especially if it is perceived as additional work on already overburdened staff).
See the supplemental infographic below: