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.
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This article argues for an updated theoretical framework in fashion studies. It proposes that perspectives emphasizing the social role and the technological nature of dress should be considered complementary, and that their joint application can contribute to new understandings of fashion history. Employing ethnographic methods, this stance is explored through a comparative analysis of the sartorial practices of two groups of women living or working in Amsterdam during the 1950s and the 2010s. A theoretical framework integrating theories of identity (mainly based on the writings of Georg Simmel and Gabriel Tarde) and the philosophy of technology (in this case the device paradigm of Albert Borgmann) allows us to uncover a paradoxical history of fashion in which clothing shifts roles, transforming from “things of imitation” into “devices of differentiation.”
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This paper investigates how management accounting and control systems (operationalized by using Simons’ (1995a) levers of control framework) can be used as devices to support public value creation and as such it contributes to the literature on public value accounting. Using a mixed methods case study approach, including documentary analysis and semi-structured interviews, we found diverging uses of control systems in the Dutch university of applied sciences we investigated. While belief and interactive control systems are used intensively for strategy change and implementation, diagnostic controls were used mainly at the decentral level and seen as devices to make sure that operational and financial boundaries were not crossed. Therefore, belief and interactive control systems lay the foundation for the implementation of a new strategy, in which concepts of public value play a large role, using diagnostic controls to constrain actions at the operational level. We also found that whereas the institution wanted to have interaction with the external stakeholders, in daily practice this takes place only at the phase of strategy formulation, but not in the phase of intermediate strategy evaluation.
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