During the past decades deinstitutionalisation policies have led to a transition from inpatient towards community mental health care. Many European countries implement Assertive Community Treatment (ACT) as an alternative for inpatient care for “difficult to reach” children and adolescents with severe mental illness. ACT is a well-organized low-threshold treatment modality; patients are actively approached in their own environment, and efforts are undertaken to strengthen the patient’s motivation for treatment. The assumption is that ACT may help to avoid psychiatric hospital admissions, enhance cost-effectiveness, stimulate social participation and support, and reduce stigma. ACT has been extensively investigated in adults with severe mental illness and various reviews support its effectiveness in this patient group. However, to date there is no review available regarding the effectiveness of youth-ACT. It is unknown whether youth-ACT is as effective as it is in adults. This review aims to assess the effects of youth-ACT on severity of psychiatric symptoms, general functioning, and psychiatric hospital admissions.
The general aim of this dissertation is to gain insight into the physiotherapeutic validity of physiotherapy research in subjects with non-specific neck pain. Chapter 1 describes the background of the research and the research questions and gives an overview of the studies performed. Chapter 2 presents the results of a systematic review (SR) of the completeness of the clinical reasoning process within the methodology of the RCT in patients with non-specific neck pain. For the SR analysis 122 studies were included. In the majority of studies (70%) the described clinical reasoning process was incomplete. There was scarcely any association between the degree of risk of bias and the completeness of the clinical reasoning process, indicating that better methodological quality does not necessarily imply a better description of clinical reasoning process. Chapter 3 presents the results of a SR in which we sought to identify published classification systems with a targeted treatment approach (treatment-based classification systems (TBCSs)) for patients with non-specific neck pain. Thirteen TBCSs were identified. In conclusion, existing treatment-based classification systems are of moderate quality at best. Moreover, these systems were not more effective than alternative treatments. Therefore, we do not recommend the use of these systems in daily physiotherapy practice. Chapter 4 describes a Delphi study of the clinical reasoning process of physiotherapy experts in unimodal interventions in patients with non-specific neck pain. This study had three goals. First, we aimed explore the expert opinions on the indication for physiotherapy when, other than neck pain, there are no positive signs and symptoms, no positive diagnostic tests or complaints of limitations in functioning or restrictions in participation. Second, we focused on the experts' use of measurement tools and when they are used to support and objectify the clinical reasoning process. Finally, we wanted to reach consensus among experts on the use of unimodal interventions in patients with non-specific neck pain. According to all experts, pain alone was not considered to be an indication for physiotherapy. Patient reported outcome measures were mainly used for evaluative purposes and physical tests for diagnostic and evaluative purposes. Only 6 of the 18 variants of sequential linear clinical reasoning reached a consensus of more than 50%. Chapter 5 describes a review that examined the completeness of the description of manipulation and mobilization interventions in randomized controlled trials of subjects with non-specific neck pain. In conclusion, mobilization or manipulation interventions are poorly reported in RCTs, compromising the external validity of RCTs, making it difficult for clinicians and researchers to replicate these interventions. Chapter 6 investigated the diagnostic physiotherapeutic process regarding limited ROM of the neck. It can be concluded that the overall diagnostic accuracy of physical examination is limited (compared to the CROM measurement). Therefore, a measurement device should be used in daily physical therapy practice to assess if a movement direction is restricted. Chapter 7 describes an exploratory, practice-oriented study into matched treatments in patients with non-specific neck pain. The objective of this study was 1) to establish the measurement error of the used accelerometer; 2) To determine which different treatments are used; 3) To explore if the cervical ROM, pain, (perceived) disability and motor control improved after one treatment. The SCT is a reliable accelerometer for measuring neck ROM, with a small measurement error. Eight different treatments were carried out. Pain, disability and left and right rotation showed a clinically relevant improvements (exceeded the measurement error). Chapter 8 comprises the general discussion. The general discussion presents an overview of this dissertation and discusses the strengths and limitations of the studies and possible implications of the results and recommendations for future research.
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How does a specific lung cancer become resistant towards medication.The occurrence of a chromosomal translocation resulting in a ROS1 gene fusion in lung cancer is relatively rare with around 1-2% of all cases. Both Dutch (Stichting Merels Wereld) and world-wide (ROS1ders) patient advocacy groups work hard to raise awareness and bring researchers together to close the knowledge gap on ROS1 driven oncogenesis and increase the optionsfor treatment. A notorious hurdle is to achieve durable responses due to development of resistance.Ongoing mutations occurring in tumour cells lead to a heterogeneous genomic landscape and will result in outgrowth of the fastest growing tumour cell population resistant to the applied drug. The currently known resistance mechanisms can be divided in on-target (i.e. mutations in the kinasedomain of ROS1) and off-target (providing ROS1 independent growth support) mechanisms. The currently available drugs target the ROS1-fusion gene positive lung cancer cells. In addition, some of the drugs also target cancer cells with specific ROS1 resistance mutations allowing effective sequentialtreatment upon disease progression. Selection of the most optimal treatment is largely a ‘trial and error’ approach. Patients and their doctors ask for better prediction of the most effective follow-up treatment upon development of resistance. Medical Life Science & Diagnostics can help to improvetreatment by developing cell culture models which mimic the situation in resistant tumour cells.Understanding the impact of specific mutations on disease behaviour will aid in the development of patient-tailored therapeutic approaches, ultimately improving patient outcomes.
communicative participation, language disordersOBJECTIVE(S)/RESEARCH QUESTION(S) Speech and language therapists (SLTs) are the primary care professionals to treat language and communication disorders. Their treatment is informed by a variety of outcome measures. At present, diagnosis, monitoring of progress and evaluation are often based on performance-based and clinician-reported outcomes such as results of standardized speech, language, voice, or communication tests. These tests typically aim to capture how well the person can produce or understand language in a controlled situation, and therefore only provide limited insight in the person’s challenges in life. Performance measures do not incorporate the unobservable feelings such as a patient's effort, social embarrassment, difficulty, or confidence in communication. Nor do they address language and communication difficulties experienced by the person themselves, the impact on daily life or allow patients to set goals related to their own needs and wishes. The aim of our study is give our patients a voice and empower SLTs to incorporate their patient's perspective in planning therapy. We will Aangemaakt door ProjectNet / Generated by ProjectNet: 08-12-2020 12:072Subsidieaanvraag_digitaal / Grant Application_digitaalDossier nummer / Dossier number: 80-86900-98-041DEFINITIEFdevelop a valid and reliable patient-reported outcome measure that provides information on communicative participation of people with communication disorders and integrate this item bank in patient specific goal setting in speech and language therapy. Both the item bank and the goal setting method will be adapted in cocreation with patients to enable access for people with communication difficulties.STUDY DESIGN Mixed methods research design following the MRC guidance for process evaluation of complex interventions, using PROMIS methodology including psychometric evaluation and an iterative user-centered design with qualitative co-creation methods to develop accessible items and the goal setting method.RESEARCH POPULATION Children, adolescents and adults with speech, language, hearing, and voice disorders.OUTCOME MEASURES An online patient-reported outcome measure on communicative participation, the Communicative Participation Item Bank (CPIB), CPIB items that are accessible for people with language understanding difficulties, a communicative-participation person-specific goal setting method developed with speech and language therapists and patients and tested on usability and feasibility in clinical practice, and a course for SLTs explaining the use of the goal-setting method in their clinical reasoning process.RELEVANCE This study answers one of the prioritized questions in the call for SLTs to systematically and reliably incorporate the clients’ perspective in their daily practice to improve the quality of SLT services. At present patient reported outcomes play only a small role in speech and language therapy because 1) measures (PROMS) are often invalid, not implemented and unsuitable for clinical practice and 2) there is a knowledge gap in how to capture and interpret outcomes from persons with language disorders.
Antimicrobial Resistance (AMR), the ability of micro-organisms to resist antibiotics, is associated with ~4.9 million deaths globally, reported in 2022. In the EU alone, more than 35.000 people die from antimicrobial-resistant infections annually, resulting in loss of life as well as €1.5Bn/year in healthcare costs and productivity losses. Rapid diagnostics tests are needed, current testing takes between 24 hours to a few days (for slow growing microorganisms), delaying patient treatment and severely impacting treatment outcomes. SoundCell BV have developed a technique (TRL5), for real-time detection of bacteria's viability in the presence of antibiotics. Nano-mechanical vibration of an ultrathin graphene sheet correlates to viability of bacteria immobilized on this sheet. Bacterial motion is transferred to this sheet, and movement of this sheet is tracked via a high-speed laser. Living bacteria produce a strong signal, which diminishes when antibiotics kill them. Unaffected by growth rates, results are achieved in one hour with this technique. This technology opens up possibility for rapid diagnostics of antibiotic resistance in patients with infections of slow growing pathogens (such as mycobacteria and yeast). In such cases the time to result is slowest, significantly delaying effective patient treatment. We aim to validate this technique in our clinical microbiology laboratory.
