Mastication Dyspraxia: A Neurodevelopmental Disorder Reflecting Disruption of the Cerebellocerebral Network Involved in Planned Actions

This paper reports the longitudinal clinical, neurocognitive, and neuroradiological findings in an adolescent patient with nonprogressive motor and cognitive disturbances consistent with a diagnosis of developmental coordination disorder (DCD). In addition to prototypical DCD, the development of mastication was severely impaired, while no evidence of swallowing apraxia, dysphagia, sensorimotor disturbances, abnormal tone, or impaired general cognition was found. He suffered from bronchopulmonary dysplasia and was ventilated as a newborn for 1.5 months. At the age of 3 months, a ventriculoperitoneal shunt was surgically installed because of obstructive hydrocephalus secondary to perinatal intraventricular bleeding. At the age of 5 years, the patient’s attempts to masticate were characterized by rough, effortful, and laborious biting movements confined to the vertical plane. Solid food particles had a tendency to get struck in his mouth and there was constant spillage. As a substitute for mastication, he moved the unground food with his fingers in a lateral direction to the mandibular and maxillary vestibule to externally manipulate and squeeze the food between cheek and teeth with the palm of his hand. Once the food was sufficiently soft, the bolus was correctly transported by the tongue in posterior direction and normal deglutition took place. Repeat magnetic resonance imaging (MRI) during follow-up disclosed mild structural abnormalities as the sequelae of the perinatal intraventricular bleeding, but this could not explain impaired mastication behavior. Quantified Tc-99m-ethylcysteinate dimer single-photon emission computed tomography (Tc-99m-ECD SPECT), however, revealed decreased perfusion in the left cerebellar hemisphere, as well as in both inferior lateral frontal regions, both motor cortices, and the right anterior and lateral temporal areas. Anatomoclinical findings in this patient with DCD not only indicate that the functional integrity of the cerebellocerebral network is crucially important in the planning and execution of skilled actions, but also seem to show for the first time that mastication deficits may be of true apraxic origin. As a result, it is hypothesized that “mastication dyspraxia” may have to be considered as a distinct nosological entity within the group of the developmental dyspraxias following a disruption of the cerebellocerebral network involved in planned actions

Telemedicine in interdisciplinary work practices: On an IT system that met the criteria for success set out by its sponsors, yet failed to become part of every-day clinical routines

Background. Information systems can play a key role in care innovations including task redesign and shared care. Many demonstration projects have presented evidence of clinical and cost effectiveness and high levels of patient satisfaction. Yet these same projects often fail to become part of everyday clinical routines. The aim of the paper is to gain insight into a common paradox that a technology can meet the criteria for success set out at the start of the project yet fail to become part of everyday clinical routines. Methods. We evaluated a telecare service set up to reduce the workload of ophthalmologists. In this project, optometrists in 10 optical shops made digital images to detect patients with glaucoma which were furth

To Deliver or Not to Deliver Cognitive Behavioral Therapy for Eating Disorders: Replication and Extension of Our Understanding of Why Therapists Fail to Do What They Should Do

Objective: This study investigated the extent to which therapists fail to apply empirically supported treatments in a sample of clinicians in The Netherlands, delivering cognitive behavioral therapy for eating disorders (CBT-ED). It aimed to replicate previous findings, and to extend them by examining other potential intra-individual factors associated with the level of (non-)use of core CBT-ED techniques. Method: Participants were 139 clinicians (127 women; mean age 41.4 years, range = 24-64) who completed an online survey about the level of use of specific techniques, their beliefs (e.g., about the importance of the alliance and use of pretreatment motivational techniques), anxiety (Intolerance of Uncertainty Scale), and personality (Ten Item Personality Inventory). Results: Despite some differences with Waller’s (2012) findings, the present results continue to indicate that therapists are not reliably delivering the CBT-ED techniques that would be expected to provide the best treatment to their patients. This ‘non-use’ appears to be related to clinician anxiety, temporal factors, and clinicians’ beliefs about the role of the therapeutic alliance in driving therapy outcomes. Discussion: Improving treatment delivery will involve working with clinicians’ levels of anxiety, clarifying the lack of benefit of pre-therapy motivational enhancement work, and reminding clinicians that the therapeutic alliance is enhanced by behavioral change in CBT-ED, rather than the other way around

Vernet ziekteverzuim database

Deze registratie is met ingang van 2013 gestopt. De registratie bestaat uit de primaire werknemers- en verzuimgegevens van de organisaties die geabonneerd zijn op een of meer Vernetproducten. Onder primaire gegevens wordt verstaan: datum indiensttreding en datum uitdiensttreding, data ziek- en herstelmelding, mutatiedata voor loon, arbeidsongeschiktheidspercentage (ao%), part-time percentage (pt%), kostenplaatsen, organisatorische eenheden enzovoort

PREZIES: Prevention of hospital-aquired infections through surveillance. Surgical site infections component III, 1997-1999

In the period of January 1995 December 1999, 65 hospitals collected data on 72,720 operations after which 2,493 surgical site infections (SSIs) occurred. For 14 operation groups and 88 procedures the incidence of SSIs was calculated. The infection rates for specific procedures ranged from 0% for various procedures to 14,4% for resections of the small intestine. In 1,376 of 2,493 infections (55%) a total of 2,025 microorganisms were reported. In infections after clean surgery Staphylococcus species were isolated most frequently. In other infections this was Eschericia coli, followed by Interococcus species and Staphylococcus aureus.In de periode van januari 1995 - december 1999 hebben 65 ziekenhuizen gegevens geregistreerd over 72.720 operaties waarbij 2.493 postoperatieve wondinfecties ontstonden. Voor 14 operatiegroepen en 88 ingrepen is de nncidentie van wondinfecties bepaald. De infectiepercentages voor afzonderlijke ingrepen liepen uiteen van 0% voor diverse operaties tot 14,4% voor dunne darmresecties. Bij 1.376 van de 2.493 infecties (55%) zijn in totaal 2.025 micro-organismen gerapporteerd. Bij infecties na een schone ingreep werden Staphylococcus species het meest geisoleerd. Bij overige infecties was dit Escherichia coli, gevolgd door Enterococcus species en Staphylococcus aureus