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3BACKGROUND: Since 2011, a tailored, interdisciplinary head and neck rehabilitation (IHNR) program, covered by the basic healthcare insurance, is offered to advanced head and neck cancer (HNC) patients in the Netherlands Cancer Institute (NKI). This program is developed to preserve or restore patients' functioning, and to optimize health-related quality of life (HRQoL). It applies an integrated approach to define patients' individual goals and provide rehabilitation care throughout the cancer care continuum. The aim of the current study is to assess the (cost-) effectiveness of the IHNR approach compared to usual supportive care (USC) consisting of monodisciplinary and multidisciplinary care in advanced HNC patients.
METHODS: This multicenter prospective observational study is designed to compare (cost-)effectiveness of the IHNR to USC for advanced HNC patients treated with chemoradiotherapy (CRT) or bioradiotherapy (BRT). The primary outcome is HRQoL represented in the EORTC QLQ-C30 summary score. Functional HRQoL, societal participation, utility values, return to work (RTW), unmet needs (UN), patient satisfaction and clinical outcomes are secondary outcomes, assessed using the EORTC QLQ-H&N35, USER-P, EQ-5D-5 L, and study-specific questionnaires, respectively. Both patient groups (required sample size: 64 per arm) are requested to complete the questionnaires at: diagnosis (baseline; T0), 3 months (T1), 6 months (T2), 9 months (T3) and 12 months (T4) after start of medical treatment. Differences in outcomes between the intervention and control group will be analyzed using mixed effects models, Chi-square test and descriptive statistics. In addition, a cost-effectiveness analysis (CEA) will be performed by means of a Markov decision model. The CEA will be performed using a societal perspective of the Netherlands.
DISCUSSION: This prospective multicenter study will provide evidence on the effectiveness and cost-effectiveness of IHNR compared to USC. RTW and societal participation, included as secondary outcomes, have not been studied sufficiently yet in cancer rehabilitation. Interdisciplinary rehabilitation has not yet been implemented as usual care in all centers, which offers the opportunity to perform a controlled clinical study. If demonstrated to be (cost-)effective, national provision of the program can probably be advised.
TRIAL REGISTRATION: The study has been retrospectively registered in the Netherlands Trial Registry on April 24th 2018 ( NTR7140 ).
ARTIKEL
Cervical dystonia (CD) is a neurological movement disorder characterized by involuntary muscle contractions causing abnormal postures and/or twisting movements of the head and neck.
Patients may also experience non-motor symptoms including pain, anxiety and depression. The main treatment option is botulinum toxin (BoNT) injections in affected muscles to improve head postures and reduce pain. In addition to BoNT treatment, patients are often referred for physical therapy (PT), but there is little evidence regarding the long-term effectiveness.
Despite remarkable improvements during the last decades, there are still many unmet needs that remain open in the treatment of cervical dystonia (CD). The first goal of this thesis was to assess clinical issues in BoNT treatment that need further improvement and to define clinical recommendations for clinicians. The second goal was to explore which determinants play an important role in disability of CD patients and the third goal was to develop a specialized PT program and to evaluate its effects on disability.
Results showed that BoNT treatment can be further improved despite all the evidence for its effectiveness. Further research is needed towards optimal treatment intervals, dose equivalence between different BoNT formulations, the use of supportive techniques like electromyography or ultrasound and managing side effects. Secondly, we found that psychological factors are important determinants of disability. Finally, we found that PT is a valuable addition to BoNT treatment to improve disability and pain. Based on these findings, a multidisciplinary treatment approach to further improve the treatment and quality of life for CD patients is recommended.
ONDERZOEK INTERN, AFSTUDEREN EXTERN
In this chapter it is argued that self-direction is currently well above the head of the majority of youngsters and even of many adults. Evidence for this conclusion stems from developmental and brain research. However, for various reasons it is important that people develop the competences that are necessary for self-direction. To what degree is it possible to develop these competences? Are they 'learnable'? What can education contribute?
BOEKDEEL
Cities worldwide are growing at unprecedented rates, compromising their surrounding landscapes, and consuming many scarce resources. As a consequence, this will increase the compactness of cities and will also decrease the availability of urban green space. In recent years, many Dutch municipalities have cut back on municipal green space and itsmaintenance. To offer a liveable environment in 30 to 50 years, cities must face challenges head-on and strive to create green urban areas that build on liveable and coherent sustainable circular subsystems.
NIET BEKEND
This research focuses on dinner conversations in family-style group care. Children, who cannot live with their biological families anymore, are given shelter in these family-style group care settings. For the development of an attachment relationship between children and their Professional Foster Parents (PFPs), it is important that the children feel that they are listened to in order to get an affective and intimate relationship with the parents. In this conversation-analytic research we analysed PFPs’ involvement in multiple activities simultaneously, namely listening and eating, which is referred to as ‘multi-activity’. The analyses have shown systematic ways in which PFPs coordinate their involvement in the activities of ‘doing’ listening and eating, which are (i) when parents avert their gaze from the telling child, they break the social rule which states that hearers need to look at speakers during the telling. We found that when averting their gaze, PFPs do head nods and linguistic means or positioning their bodies in the direction of the telling child. This research contributes to knowledge about interaction between adolescents and PFPs. It further contributes to knowledge about how human beings are able to coordinate multiple activities simultaneously. This is the accepted version (post-print) of the article.
ARTIKEL
Lectorale Rede van Harmieke van Os, woensdag 17-09-2025: In mijn rede heb ik uiteengezet dat het lectoraat Innovatie in de oncologische (netwerk)zorg zich richt op persoonsgerichte essentiële zorg door verpleegkundigen en verpleegkundig specialisten. Die zorg start in de zorgrelatie. Verpleegkundigen en verpleegkundig specialisten staan voor complexe opgaven: de zorgvraag neemt toe, terwijl er minder verpleegkundigen zijn, de impact van kanker op patiënten en hun naasten is groot en gezondheidsverschillen spelen een rol. Om persoonsgerichte zorg te bieden werken zij nauw samen in netwerken, zetten ze in op preventie en een gezonde leefstijl en maken ze gebruik van (digitale) innovaties. Het lectoraat wil via praktijkgericht onderzoek bijdragen aan de kwaliteit van leven en sterven van patiënten met kanker, en aan de professionalisering van verpleegkundigen en verpleegkundig specialisten. Ik heb een schets gegeven van drie met elkaar samenhangende onderzoeksthema’s: • Interprofessionele samenwerking in (netwerk)zorg; • Preventie door leefstijlverpleegkunde; • Innoveren in de oncologische zorg. Samenwerking is hierin essentieel. Ik heb het belang toegelicht van samenwerking met patiënten, verpleegkundigen, verpleegkundig specialisten, professionals uit zorg- en aanpalende domeinen, docenten en studenten. Samen werken we aan persoonsgerichte zorg!
LEZING
De potentie van maakplaatsen als een laagdrempelige publieke plek, ingebed in de lokale gemeenschap, is enorm. Niettemin blijken veel maakplaatsen na een enthousiaste start te stuiten op een gebrek aan personeel en expertise. Ook blijft het aanbod vaak beperkt tot educatieve activiteiten voor de jeugd, in aanvulling op het digitale curriculum dat kinderen op school veelal ontberen. In 2018 deden de TU Delft, de Hogeschool Rotterdam en de KB voor het eerst samen landelijk onderzoek naar de trend van maakplaatsen in openbare bibliotheken. Daarin werd onder meer de spreiding van maakplaatsen in Nederland in kaart gebracht, een overzicht gemaakt van een selectie van typische maakplaatsen en een roadmap ontwikkeld voor programmering van maakplaatsen als aanjagers van 21e eeuwse vaardigheden. Vanuit de overtuiging dat er meer mogelijk is en dat maakplaatsen in de kern de perfecte match vormen met de bibliotheek, is met project MAKERLAB (2021-2022) het concept van de maakplaats een slag verder gebracht. Dat daarvoor expertise van buitenaf nodig is, stond sinds het begin van dit proces vast. Maakplaatsen vormen zowel een uitdaging voor de inrichting van de fysieke ruimte als een opgave voor medewerkers van de bibliotheek. Het publiek is grotendeels nog onbekend met het concept, dus ook qua bereik en impact zijn er uitdagingen. Met een interdisciplinaire aanpak is de maakplaats als te onderzoeken concept concreet gemaakt vanuit drie invalshoeken: het ruimtelijk ontwerp, de programmering, en de inbedding en impact in de lokale omgeving. Uit het bibliotheeknetwerk zijn zowel provinciale ondersteuningsinstellingen als lokale bibliotheken geselecteerd om het onderzoek in praktijk te brengen.
RAPPORT
Sicca syndrome (dry mouth and dry eyes) occurs predominantly due to the side effects of medication, systemic diseases (Sjögren’s disease), and radiotherapy of the head and neck region. Sicca complaints decrease the quality of life, cause sleep disturbances, and affect overall health. This systematic literature review investigates the correlation and/or association between dry mouth and dry eyes. A comprehensive search was conducted through PubMed and Web of Science databases up to November 2024. English-language research studies investigating the association and/or correlation between dry mouth and dry eyes were included. Study quality was assessed using NIH quality assessment tools. Data on publication details, participant characteristics, assessment methods, and outcomes was extracted and synthesised based on the type of outcome (objective and/or subjective assessments) and cohort type.
ARTIKEL
This six-year study, consisting of four sub-investigations (one conceptual, three empirical), describes how subjectifying education with positioning of the body and embodiment of students in the educational practice requires teacher artistry, and forms by which teachers can stimulate learners' desire to become an embodied person in the world. The purpose of this research is to reconsider subjectification as the main target domain of education from the perspective of embodied cognition. The main research question is: How can Dutch teachers develop their artistry to create an inclusive educational practice that encourages their learners (in Dutch (v)mbo and higher education) to become embodied persons situated in the world? Since schools and classrooms are mini societies, there are many opportunities in these settings for learners' encounters with the world and their micro sociocultural worlds. Qualities like feeling what is happening inside oneself, expression of emotions, reflection and reflexivity, being able to be where the other is, having meaningful relationships with teachers and other learners, and engaging with the world are important for learners' wellbeing (De Haan, 2021; Zembylas, 2007; Zheng, 2022). The sort of curriculum that would pedagogically foster the development of these qualities in education is more likely to have the learner's body (or better, their embodied mind, Varela et al., 1992) at a central position in teaching and learning, thus enhancing opportunities for emotional and bodily expression (Zembylas, 2007). An overarching conclusion follows to answer the main research question. Teaching is not implementing a method or proven intervention 'that works' in the classroom, nor is it following a recipe (Biesta, in publication). It is both craft (technē) and art (including practical knowledge, phronesis) (Eisner, 2002). Through constant attention to embodied perception in the curriculum and evoking aesthetic experiences (Stenhouse, 1988), through 'making', working with 'experientiality' (Caracciolo, 2019) and 'doing the arts', giving shape to the environment (Alibali & Nathan, 2018), vitality, emotions, uncertainties and unpredictable activities and outcomes (Eisner, 1985), teachers develop their artistry. It is important for teachers to come together, add knowledge to each other and make education together. They have a responsibility to create inclusive spaces in the classroom for plurality and possible transformation. There are at least three current barriers in Dutch education that make it difficult for teachers to create inclusive spaces in the classroom: the Dutch 'measurement culture', the gap between academic "for the head" and vocational "for the hand" education, and Cartesian dualism as the paradigm underlying education. These three barriers do not disappear when teachers 'make' and 'do arts' with their learners' Artistic principles, however, in addition to recognizing the embodiment of learners, spark the joy of improvisation and experimentation and inspire teachers to further develop their teacher artistry. Schools then become spaces where teachers approach their learners as embodied persons who are in the world, rather than as individuals with separate brains, and bodies that are not being addressed. This is an important step toward embodied subjectification in education.
PROEFSCHRIFT
