Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of "European Guidelines for the Management of RDS " by a panel of experienced... Show moreRespiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of "European Guidelines for the Management of RDS " by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12(,) 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS). Show less
Sweet, D.G.; Carnielli, V.; Greisen, G.; Hallman, M.; Ozek, E.; Pas, A. te; ... ; Halliday, H.L. 2019
PurposeTo assess awareness of, opinion about and adherence to evidence-based guidelines on chronic rhinosinusitis among Dutch Otolaryngologists.MethodsWe assessed implementation of two guidelines,... Show morePurposeTo assess awareness of, opinion about and adherence to evidence-based guidelines on chronic rhinosinusitis among Dutch Otolaryngologists.MethodsWe assessed implementation of two guidelines, one Dutch and one European, that are both intended for diagnosis and treatment of patients with chronic rhinosinusitis. We invited 485 Otolaryngologists to fill out a questionnaire and report on their opinion on and adherence to the guidelines. The adherence was further tested by 4 clinical case scenarios, derived from guideline recommendations.Results166 (34%) completed the questionnaire. 99% of the respondents was aware of one or both guidelines. Most respondents (90%) consider the guidelines as directing or supportive for their clinical practice based on the clinical case scenarios, between 62 and 99% of the respondents act according to guidelines. Concerning diagnosis, CT-imaging is performed more and allergy testing less than recommended. Where multiple treatment options are recommended, the responses are more heterogeneous as a result of this. Nonetheless, high recommended treatment was chosen more often. Otolaryngologists were reluctant in surgical treatment as a first option, which is according to the guidelines.ConclusionsOverall, both the EPOS and CBO guideline are well known among Dutch Otolaryngologists and 90% indicates that the guideline is important in their daily practice. Adherence to the guidelines is sufficient to high. If multiple treatment or diagnostic options are recommended this leads to a more heterogeneous response pattern. Recommendations with a high grade of recommendation were followed up most often. 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
