Non-violent Resistance (NVR) is a method to manage child and adolescent aggressive behavior and to decrease parental helplessness. Although developed for a family setting, this paper describes the... Show moreNon-violent Resistance (NVR) is a method to manage child and adolescent aggressive behavior and to decrease parental helplessness. Although developed for a family setting, this paper describes the adaptation of NVR for child and adolescent residential settings, reports on the possible hampering and facilitating elements of implementing NVR in four different institutions and finally presents seclusion and restraint rates before and after implementation. Retrospective analysis of the different implementation processes suggested the following dements to facilitate implementation: awareness that NVR is not a quick fix, a considerable amount of time and financial investment, a team-wide perspective, support from all levels in an organization and influential team members committed to NVR to decrease the risk of falling back into more familiar patterns. Seclusion and restraint figures pre-post point in the direction that the implementation of an adapted version of NVR in residential settings could result in decreased seclusion and restraint. Furthermore, this decrease was most pronounced in sites with a successful implementation process. This observational study provides a starting point for an empirical basis for the use of NVR within child and adolescent residential settings. Further research on successful implementation processes for multi-level, milieu-based interventions, such as NVR, is required. Show less
Brouns, B.; Meesters, J.J.L.; Wentink, M.M.; Kloet, A.J. de; Arwert, H.J.; Boyce, L.W.; ... ; Bodegom-Vos, L. van 2019
Introduction Expectations of physicians concerning e-Health and perceived barriers to implementation in clinical practice are scarcely reported in the literature. The purpose of this study was to... Show moreIntroduction Expectations of physicians concerning e-Health and perceived barriers to implementation in clinical practice are scarcely reported in the literature. The purpose of this study was to assess these aspects of cardiovascular e-Health.Methods A survey was sent to members of the Netherlands Society of Cardiology. In total, the questionnaire contained 30 questions about five topics: personal use of smartphones, digital communication between respondents and patients, current e-Health implementation in clinical practice, expectations about e-Health and perceived barriers for e-Health implementation. Age, personal use of smartphones and professional environment were noted as baseline characteristics.Results In total, 255 respondents filled out the questionnaire (response rate 25%); 89.4% of respondents indicated that they considered e-Health to be clinically beneficial, improving patient satisfaction (90.2%), but also that it will increase the workload (83.9%). Age was a negative predictor and personal use of smartphones was a positive predictor of having high expectations. Lack of reimbursement was identified by 66.7% of respondents as a barrier to e-Health implementation, as well as a lack of reliable devices (52.9%) and a lack of data integration with electronic medical records (EMRs) (69.4%).Conclusion Cardiologists are in general positive about the possibilities of e-Health implementation in routine clinical care; however, they identify deficient data integration into the EMR, reimbursement issues and lack of reliable devices as major barriers. Age and personal use of smartphones are predictors of expectations of e-Health, but the professional working environment is not. Show less
Voorn, V.M.A.; Bodegom-Vos, L. van; So-Osman, C. 2018
Aim: Fluoropyrimidines are commonly used anti-cancer drugs, but lead to severe toxicity in 10-30% of patients. Prospective DPYD screening identifies patients at risk for toxicity and leads to a... Show moreAim: Fluoropyrimidines are commonly used anti-cancer drugs, but lead to severe toxicity in 10-30% of patients. Prospective DPYD screening identifies patients at risk for toxicity and leads to a safer treatment with fluoropyrimidines. This study evaluated the routinely application of prospective DPYD screening at the Leiden University Medical Center. Methods: Prospective DPYD screening as part of routine patient care was evaluated by retrospectively screening databases and patient files to determine genotype, treatment, dose recommendations and dose adjustments. Results: 86.9% of all patients with a first fluoropyrimidine prescription were screened. Fourteen out of 275 patients (5.1%) carried a DPYD variant and received a 25-50% dose reduction recommendation. None of the patients with a DPYD variant treated with a reduced dose developed toxicities. Conclusion: Prospective DPYD screening can be implemented successfully in a real world clinical setting, is well accepted by physicians and results in low toxicity. Show less
Helmerhorst, H.J.F.; Schultz, M.J.; Voort, P.H.J. van der; Bosman, R.J.; Juffermans, N.P.; Wilde, R.B.P. de; ... ; Jonge, E. de 2016
