Background Total laryngectomy with or without adjuvant (chemo)radiation often induces speech, swallowing and neck and shoulder problems. Speech, swallowing and shoulder exercises may prevent or diminish these problems. The aim of the present paper is to describe the study, which is designed to investigate the effectiveness and cost-utility of a guided self-help exercise program built into the application “In Tune without Cords” among patients treated with total laryngectomy. Methods/design Patients, up to 5 years earlier treated with total laryngectomy with or without (chemo)radiation will be recruited for participation in this study. Patients willing to participate will be randomized to the intervention or control group (1:1). Patients in the intervention group will be provided access to a guided self-help exercise program and a self-care education program built into the application “In Tune without Cords”. Patients in the control group will only be provided access to the self-care education program. The primary outcome is the difference in swallowing quality (SWAL-QOL) between the intervention and control group. Secondary outcome measures address speech problems (SHI), shoulder disability (SDQ), quality of life (EORTC QLQ-C30, QLQ-H&N35 and EQ-5D), direct and indirect costs (adjusted iMCQ and iPCQ measures) and self-management (PAM). Patients will be asked to complete these outcome measures at baseline, immediately after the intervention or control period (i.e. at 3 months follow-up) and at 6 months follow-up. Discussion This randomized controlled trial will provide knowledge on the effectiveness of a guided self-help exercise program for patients treated with total laryngectomy. In addition, information on the value for money of such an exercise program will be provided. If this guided self-help program is (cost)effective for patients treated with total laryngectomy, the next step will be to implement this exercise program in current clinical practice.
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of skeletal muscle training on functional performance in people with spinal muscular atrophy (SMA) type 3 and to identify any adverse effects
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.
