Antidepressants during pregnancy: Guideline adherence and current practice amongst Dutch gynaecologists and midwives.

BACKGROUND AND OBJECTIVES: prescription rates of antidepressants during pregnancy range from 2-3% in The Netherlands to 6.2% in the USA. Inconclusive evidence about harms and benefits of antidepressants during pregnancy leads to variation in advice given by gynaecologists and midwives. The objective was to investigate familiarity with, and adherence to the Dutch multidisciplinary guideline on Selective Serotonin Reuptake Inhibitor (SSRI) use during pregnancy by gynaecologists and midwives in the Netherlands. METHODS: an online survey was developed and send to Dutch gynaecologists and midwives. The survey consisted mainly of multiple-choice questions addressing guideline familiarity and current practice of the respondent. Also, caregiver characteristics associated with guideline adherence were investigated. FINDINGS: a total of 178 gynaecologists and 139 midwives responded. Overall familiarity with the Dutch guideline was 92.7%. However, current practice and advice given to patients by caregivers differed substantially, both between gynaecologists and midwives as well as within both professions. Overall guideline adherence was 13.9%. Multivariable logistic regression showed that solely caregiver profession was associated with guideline adherence, with gynaecologists having a higher adherence rate (OR 2.10, 95%CI 1.02-4.33) than midwives. KEY CONCLUSION: although reported familiarity with the guideline is high, adherence to the guideline is low, possibly resulting in advice to patients that is inconsistent with guidelines and unwanted variation in current practice. IMPLICATIONS FOR PRACTICE: further implementation of the recommendations as given in the guideline should be stimulated. Additional research is needed to examine how gynaecologists and midwives can be facilitated to follow the recommendations of the clinical guideline on SSRI use during pregnancy.

Feasibility and test-retest reliability of measuring lower­limb strength in young children with cerebral palsy.

BACKGROUND: Quantifying leg muscle strength in young children with cerebral palsy (CP) is essential for identifying muscle groups for treatment and for monitoring progress. AIM: To study the feasibility, intratester reliability and the optimal test design (number of test occasions and repetitions) of measuring lower-limb strength with handheld dynamometry (HHD) and dynamic ankle plantar flexor strength with the standing heel-rise (SH) test in 3-10 year aged children with CP. DESIGN: Test-retest design. SETTING: Rehabilitation centre, special needs school for children with disabilities, and university medical centre. METHODS: Knee extensor, hip abductor and calf muscle strength was assessed in 20 ambulatory children with spastic CP (3-5 years [N.=10] and 6-10 years [N.=10]) on two test occasions. Intraclass correlation coefficients (ICC) and Smallest Detectable Differences (SDD) were calculated to determine the optimal test design for detecting changes in strength. RESULTS: All isometric strength tests had acceptable SDDs (9-30%), when taking the mean values of 2-3 test occasions (separate days) and 2-3 repetitions. The one-leg SH test had large SDDs (40-128% for younger group, 23-48% for older group). CONCLUSION: Isometric strength (improvements) can only be measured reliably with HHD in young children with CP when the average values over at least 2 test occasions are taken. Reliability of the SH test is not sufficient for measuring individual changes in dynamic muscle strength in the younger children. CLINICAL REHABILITATION IMPACT: Results of this study can be used to determine the optimal number of test occasions and repetitions for reliable HHD measurements depending on expected changes, muscle group and age in 3-10 year old children with CP.

Development and validation of an assessment instrument for teaching evidence-based practice to students in allied health care: the Dutch Modified Fresno.

UNLABELLED: To enable students to become competent evidence-based working professionals, teaching evidence-based practice (EBP) to students in allied health care has to be effective. Measuring effectiveness of EBP curricula, however, appears to be difficult due to the lack of valid instruments for this target population. The effort needed to develop and validate a new instrument is easily underestimated. This article details this process applied to an existing EBP measurement tool. AIMS: This study focuses on the development and validation of an instrument measuring the effectiveness of teaching EBP to Dutch students in allied health care. METHODS: The instrument was developed from a translated Fresno Test, using a Delphi panel where face validity was assessed. To determine reliability and construct validity, we used a cross-sectional design with four groups of students (n = 169 total) with different levels of education in EBP. RESULTS: Cronbach's alpha was 0.832, and inter-rater reliability ICC was 0.985 (95% CI 0.976-0.991). The content validity index was 0.92. Mean scores of all four groups were statistically different from each other on a p < 0.05 level. Responsiveness was 3.2 for more extreme groups and 0.9 for more similar groups. CONCLUSION: The Dutch Modified Fresno is a reliable and valid instrument to measure effects of teaching EBP in the domains knowledge and skills in the aforementioned population. The instrument is able to detect minimal important changes over time.