Background: Cervical dystonia is characterized by involuntary muscle contractions of the neck and abnormal head positions that affect daily life activities and social life of patients. Patients are usually treated with botulinum toxin injections into affected neck muscles to relief pain and improve control of head postures. In addition, many patients are referred for physical therapy to improve their ability to perform activities of daily living. A recent review on allied health interventions in cervical dystonia showed a lack of randomized controlled intervention studies regarding the effectiveness of physical therapy interventions.Methods/design: The (cost-) effectiveness of a standardized physical therapy program compared to regular physical therapy, both as add-on treatment to botulinum toxin injections will be determined in a multi-centre, single blinded randomized controlled trial with 100 cervical dystonia patients. Primary outcomes are disability in daily functioning assessed with the disability subscale of the Toronto Western Spasmodic Torticollis Rating Scale. Secondary outcomes are pain, severity of dystonia, active range of motion of the head, quality of life, anxiety and depression. Data will be collected at baseline, after six months and one year by an independent blind assessor just prior to botulinum toxin injections. For the cost effectiveness, an additional economic evaluation will be performed with the costs per quality adjusted life-year as primary outcome parameter.Discussion: Our study will provide new evidence regarding the (cost-) effectiveness of a standardized, tailored physical therapy program for patients with cervical dystonia. It is widely felt that allied health interventions, including physical therapy, may offer a valuable supplement to the current therapeutic options. A positive outcome will lead to a greater use of the standardized physical therapy program. For the Dutch situation a positive outcome implies that the standardized physical therapy program forms the basis for a national treatment guideline for cervical dystonia.Trial registration: Number Dutch Trial registration (Nederlands Trial Register): NTR3437.
Dit expertisecentrum stelt zich ten doel de kennis op het gebied van mediation te bevorderen en verder te ontwikkelen.
Verpleegkundigen, werkzaam in de zorgpraktijk, dienen hun kennis en kunde gedurende hun carrière continu bij te houden en te ontwikkelen. Dit leidde bij het HagaZiekenhuis tot de vraag aan De Haagse Hogeschool om hun verpleegkundigen een bijscholing medische biologie te geven. Maar hoe toets je het toepassen van deze kennis in de verpleegkundige praktijk? Het hbo-v-team ontwikkelde hiervoor een nieuwe toetsvorm waarbij de medische kennis van deelnemers op toepassingsniveau wordt beoordeeld in een gesimuleerd multidisciplinair overleg. In deze leerpraktijk wordt deze toetsvorm verder toegelicht, en de eerste ervaringen van deelnemers, docenten en externe beoordelaars beschreven.
Within the framework of resource efficiency it is important to recycle and reusematerials, replace fossil fuel based products with bio-based alternatives and avoidthe use of toxic substances. New applications are being sought for locally grownbiomass. In the area of Groningen buildings need reinforcement to guarantee safetyfor its users, due to man-induced earthquakes. Plans are to combine the workneeded for reinforcement with the improvement of energy performance of thesebuildings. The idea is to use bio-based building materials, preferably grown andprocessed in the region.In this study it is investigated whether it is feasible to use Typha (a swap plant) as abasis for a bio-based insulation product. In order to start the activities necessary tofurther develop this idea into a commercial product and start a dedicated company,a number of important questions have to be answered in terms of feasibility. Thisstudy therefore aims at mapping economic, organisational and technical issues andassociated risks and possibilities. On the basis of these results a developmenttrajectory can be started to set up a dedicated supply chain with the appropriatepartners, research projects can be designed to develop the missing knowledge andthe required funding can be acquired.
