This thesis starts with a literature review on the observation of aggression, then describes the development and implementation of an Observation Checklist in 2 Dutch Juvenile Justice Institutions ... Show moreThis thesis starts with a literature review on the observation of aggression, then describes the development and implementation of an Observation Checklist in 2 Dutch Juvenile Justice Institutions (JJI) and concludes with two papers researching the added value of data harvested with this tool, both for risk assessment and cultural sensitive assessment. Show less
The aim of this dissertation is to enhance understanding of care use by children known to have or be at risk of complex problems (CP). Children with CP have a greater need for health services than... Show moreThe aim of this dissertation is to enhance understanding of care use by children known to have or be at risk of complex problems (CP). Children with CP have a greater need for health services than the average child because their chronic physical, behavioral or emotional conditions interact and enhance their vulnerability. Worldwide, around 5% of children suffer from complex problems. They typically have high levels of care consumption, especially psychosocial care.In our studies we address factors impacting care use of children with CP, its intensity, and barriers to care. We found several risk factors for identification of these children: child’s age, adverse life events, child’s psychosocial problems, and parenting concerns. We also look at care use of multiproblem families, involving a subgroup of these children with the highest level of CP. Finally, we studied professionals to understand the challenges they meet in organizing care for these children when using Wraparound Care. This care-coordination method is used in the Netherlands as the backbone of treatment for children with CP. Further development of Wraparound Care and greater understanding of the factors impacting care use by children with CP will help to make their pathway to care more efficient and effective. Show less
Pharmacogenomics (PGx) utilizes an individual’s germline genetic profile to identify those who are at higher risk for ADRs or lack of efficacy. This information can be used by healthcare... Show morePharmacogenomics (PGx) utilizes an individual’s germline genetic profile to identify those who are at higher risk for ADRs or lack of efficacy. This information can be used by healthcare professionals (HCPs) to guide dose and drug selection before drug initiation in an effort to optimize drug therapy through precision medicine. Despite both the promise of and the progress in the field of PGx to achieve precision medicine, it is still not routinely applied in patient care. As such, a number of barriers preventing implementation have been identified. These include the undetermined model for delivering PGx, the lack of evidence supporting a PGx panel approach and the lack of tools supporting implementation. Therefore, the work of this thesis aims to support the implementation of precision medicine using PGx panel testing. It reports on generating evidence for PGx panel testing (Part I) and the development of tools facilitating implementation (Part II), evaluates the implementation process utilizing these tools (Part III) and quantifies the impact of PGx implementation on patient outcomes and cost-effectiveness (Part IV). Show less
With the issuing of guidance documents the European Commission assists the Member States in the implementation of Union law. This thesis seeks to unravel the process of governance through guidance... Show moreWith the issuing of guidance documents the European Commission assists the Member States in the implementation of Union law. This thesis seeks to unravel the process of governance through guidance by tracing its role and legal implications in the Dutch legal order.The first part explores the use of guidance documents by Dutch authorities and courts. Along the lines of five types of guidance and four perspectives on their binding force, different roles of guidance are discerned. National courts act as counterbalancing or facilitating actors by reinforcing or downplaying the role of guidance documents in implementation processes.The second part assesses the implications in the light of legal principles. To this end, it formulates four ‘promises’, or ideal effects, that outline how the use of guidance documents could contribute to a predictable, consistent and transparent implementation process, whilst respecting the rule of EU hard law. The analysis finds that, in practice, these ‘promises of guidance’ are not always fulfilled: a gap between promise and practice exists.The findings thus show how the issuing and use of guidance risks to challenge the rule of law that is so fundamental to the EU legal order. This thesis therefore invites to rethink governance through guidance. Show less
Musculoskeletal diseases affect many people in European communities, with rheumatoid arthritis (RA) and osteoarthritis (OA) being the most common conditions. In general, the impact of... Show moreMusculoskeletal diseases affect many people in European communities, with rheumatoid arthritis (RA) and osteoarthritis (OA) being the most common conditions. In general, the impact of musculoskeletal diseases on individuals__ lives including physical functioning is substantial, despite the growing number of effective drugs for specific rheumatic conditions. This thesis describes interventions aiming to reduce disability, with the example of interventions targeted on hand function disability as well as their evaluation, and the implementation of evidence-based interventions in daily practice, with the example of physical activity and exercise interventions for patients with RA. Show less
In many countries physiotherapy is often prescribed to PD patients, somewhere in the course of the disease. However, information about the use and efficacy of physiotherapy in PD is sparse, often... Show moreIn many countries physiotherapy is often prescribed to PD patients, somewhere in the course of the disease. However, information about the use and efficacy of physiotherapy in PD is sparse, often lacking. Therefore, the aims of this thesis are: (a) to gain better insight into the use and merits of physiotherapy for patients with PD and (b) to take a step forward in obtaining evidence-based physiotherapy for patients with PD. As a first step in this process, the efficacy of physiotherapy in PD was evaluated by means of a systematic review (Chapter 2). Secondly, the quality and quantity of current physiotherapy care in PD was evaluated by means of questionnaires sent to patients with PD and their physiotherapists (Chapter 3). Given the frequent use of physiotherapy and the lack of PD-specific expertise amongst therapists, an evidence-based guideline with practice recommendations was developed (Chapter 4). Next, we wished to examine how effective __best practice__ physiotherapy (as described in this new guideline) is for patients with PD. According to EBM recommendations, the results of an RCT provide the highest level of evidence. Therefore, we designed an RCT. To assess the feasibility of this RCT, we first performed a pilot RCT (Chapter 5). The goals of this pilot study were to examine the recruitment rate of patients, to determine the feasibility of the proposed outcome measures, to evaluate the new guideline as a tool to standardise the intervention within the experimental group and to estimate the effect size of the intervention in order to adequately power the RCT. Based on the results of this feasibility study, steps were taken to optimise two promising outcome measures: the Parkinson Activity Scale, evaluating limitations in ADL, and the Patient Specific Index, a patient preference outcome scale (Chapters 6 and 7). At the same time, the ParkinsonNet concept was developed as a novel approach to further improve the quality of physiotherapy in PD ParkinsonNet aims to improve PD-specific expertise among allied health professionals, to improve the referrals to physiotherapy by neurologists and to enhance communication between allied health professionals and neurologists. We then designed a trial to evaluate the implementation process this new ParkinsonNet concept, as well as the possible health benefits and associated costs (Chapter 8). Finally, an overview of the evolution of physiotherapy in PD was made (Chapter 9), which are presented with future challenges (Chapter 10). Show less
