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Lutomski J.E.,National University of Ireland | Lutomski J.E.,Nijmegen Center for Evidence Based Practice | Shiely F.,University College Cork | Molloy E.J.,National Maternity Hospital
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2014

Re-emerging syphilis outbreaks across Europe have led to increasing syphilis rates among women of child-bearing age. We, therefore, identified all forms of syphilis cases among women hospitalized for delivery in Ireland over a six-year period. Cases per annum ranged from 10 to 24 (13.8-32.9 per 100 000 maternities). Rates of syphilis in this universally screened cohort were four times higher than the general Irish population. Future studies examining the incidence of congenital syphilis as well as patterns in follow-up treatment for the sero-positive mother and her infant are needed to better guide clinical intervention. © 2014 Informa UK Ltd.


Fonteyn E.M.R.,Radboud University Nijmegen | Keus S.H.J.,Radboud University Nijmegen | Keus S.H.J.,Nijmegen Center for Evidence Based Practice | Verstappen C.C.P.,Canisius Wilhelmina Hospital | Van De Warrenburg B.P.C.,Radboud University Nijmegen
Cerebellum | Year: 2013

Physiotherapy plays an important role in the management of patients with degenerative cerebellar ataxias. However, our insight in the quantity and quality of physiotherapy prescription in this group of patients is incomplete. The purposes of this study were to investigate the utilization of physiotherapy and patient satisfaction in patients with degenerative ataxias in The Netherlands and to examine the level of expertise and needs of physiotherapists treating ataxia patients. Questionnaires were sent to members of the Dutch association for patients with degenerative cerebellar ataxias (n=532). In addition, 181 questionnaires were sent to the physiotherapists who had recently treated the patients who responded. Eventually, 317 questionnaires from patients (60 %) and 114 questionnaires from physiotherapists (63 %) could be used for further analysis. Sixty-four percent of the patients were currently treated by a physiotherapist. Their median treatment duration was 5 years. Nineteen percent of the patients had never been referred, often despite the presence of limitations in daily activities. On the other hand, some participants without reported limitations had received physiotherapy. In general, participants were satisfied with their physiotherapist. The most reported treatment goals were improvement or maintenance of balance, general physical condition, and mobility. Physiotherapists reported lack of ataxia-specific expertise and expressed the need for education and evidencebased guidelines. Referral to and use of physiotherapy in patients with degenerative cerebellar ataxia in The Netherlands are currently inconsistent and not in agreement with the little scientific evidence available. Referral rates are high, but referrals and actual necessity are discrepant; treatment duration is long; and ataxia-specific expertise among physiotherapists is insufficient. Evidence-based recommendations and specific training of physiotherapists are needed. © Springer Science+Business Media New York 2013.


Fonteyn E.M.R.,Radboud University Nijmegen | Keus S.H.J.,Radboud University Nijmegen | Keus S.H.J.,Nijmegen Center for Evidence Based Practice | Verstappen C.C.P.,Canisius Wilhelmina Hospital | And 4 more authors.
Journal of Neurology | Year: 2014

Many patients with cerebellar ataxia have serious disabilities in daily life, while pharmacological treatment options are absent. Therefore, allied health care is considered to be important in the management of these patients. The goal of this review is to evaluate scientific evidence for allied health care in cerebellar ataxia, to identify effective treatment strategies, and to give recommendations for clinical practice and further research. A systematic search for clinical trials concerning allied health care in cerebellar ataxias was conducted using the electronic databases of PubMed, Medline, Embase, Cinahl and Pedro, and references lists of articles, in the time period from 1980 up to and including December 2011 in English and Dutch. We identified 14 trials, of which the four best studies were formally of moderate methodological quality. There was a wide variation in disease entities and interventions. The combined data indicate that physical therapy may lead to an improvement of ataxia symptoms and daily life functions in patients with degenerative cerebellar ataxia (level 2), and in other diseases causing cerebellar ataxia (level 3). When added to physical therapy, occupational therapy might improve global functional status, and occupational therapy alone may diminish symptoms of depression (level 3). There are insufficient data for speech and language therapy. Despite the widespread use of allied health care interventions in cerebellar ataxia, there is a lack of good quality studies that have evaluated such interventions. We found some support for the implementation of physical therapy and occupational therapy, but more research is needed to develop recommendations for clinical practice. © Springer-Verlag 2013.


Oosterling I.J.,Karakter Child and Adolescent Psychiatry University Center | Wensing M.,Radboud University Nijmegen | Wensing M.,Nijmegen Center for Evidence Based Practice | Swinkels S.H.,Karakter Child and Adolescent Psychiatry University Center | And 9 more authors.
Journal of Child Psychology and Psychiatry and Allied Disciplines | Year: 2010

Background: Few field trials exist on the impact of implementing guidelines for the early detection of autism spectrum disorders (ASD). The aims of the present study were to develop and evaluate a clinically relevant integrated early detection programme based on the two-stage screening approach of Filipek et al. (1999), and to expand the evidence base for this approach. Methods: The integrated early detection programme encompassed: 1) training relevant professionals to recognise early signs of autism and to use the Early Screening of Autistic Traits Questionnaire (ESAT; Dietz, Swinkels et al., 2006; Swinkels, van Daalen, van Engeland, & Buitelaar, 2006), 2) using a specific referral protocol, and 3) building a multidisciplinary diagnostic team. The programme was evaluated in a controlled study involving children in two regions (N = 2793, range 0-11 years). The main outcome variables were a difference in mean age at ASD diagnosis and a difference in the proportion of children diagnosed before 36 months. Results: ASD was diagnosed 21 months (95% CI 9.6, 32.4) earlier in the experimental region than in the control region during the follow-up period, with the mean age at ASD diagnosis decreasing by 19.5 months (95% CI 10.5, 28.5) from baseline in the experimental region. Children from the experimental region were 9.4 times (95% CI 2.1, 41.3) more likely than children from the control region to be diagnosed before age 36 months after correction for baseline measurements. Most of these early diagnosed children had narrowly defined autism with mental retardation. Conclusions: The integrated early detection programme appears to be clinically relevant and led to the earlier detection of ASD, mainly in children with a low IQ. © 2009 Association for Child and Adolescent Mental Health.


Vinck A.,Radboud University Nijmegen | Verhagen M.M.M.,Radboud University Nijmegen | Van Gerven M.,Nijmegen Center for Evidence Based Practice | De Groot I.J.M.,Nijmegen Center for Evidence Based Practice | And 4 more authors.
Developmental Neurorehabilitation | Year: 2011

Objective: To describe cognitive and speech-language functioning of patients with ataxia-telangiectasia (A-T) in relation to their deteriorating (oculo)motor function. Design: Observational case series. Methods: Cognitive functioning, language, speech and oral-motor functioning were examined in eight individuals with A-T (six boys, two girls), taking into account the confounding effects of motor functioning on test performance. Results: All patients, except the youngest one, suffered from mild-to-moderate/severe intellectual impairment. Compared to developmental age, patients showed cognitive deficits in attention, (non)verbal memory and verbal fluency. Furthermore, dysarthria and weak oral-motor performance was found. Language was one of the patients' assets. Conclusion: In contrast to the severe deterioration of motor functioning in A-T, cognitive and language functioning appeared to level off with a typical profile of neuropsychological strengths and weaknesses. Based on our experiences with A-T, suggestions are made to determine a valid assessment of the cognitive and speech-language manifestations. © 2011 Informa UK Ltd All rights reserved.

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