Transition to adult care of young people with congenital heart disease: Impact of a service on knowledge and self-care skills, and correlates of a successful transition

Aims Less than one-third of adolescents with congenital heart disease (CHD) successfully transition to adult care, missing out on education of their cardiac condition, and risking loss to follow-up. We assessed the efficacy of our transition clinic on patient education and empowerment and identified correlates of successful transition. Methods and results Overall, 592 patients were seen at least once in our transition service between 2015 and 2022 (age 15.2 ± 1.8 years, 47.5% female). Most adolescents (53%) had moderate CHD, followed by simple (27.9%) and severe (19.1%) CHD. Learning disability (LD) was present in 18.9% and physical disability (PD) in 4.7%. In patients without LD, knowledge of their cardiac condition improved significantly from the first to the second visit (naming their condition: from 20 to 52.3%, P 0.05). Treatment adherence and management involvement, self-reported anxiety, and dental care awareness did not change over time. Successful transition (attendance of ≥ 2 clinics) was achieved in 49.3%. Younger age at the first visit, simpler CHD, and absence of PD were associated with successful transition. Conclusion A transition service positively impacts on patient education and empowerment in most CHD adolescents transitioning to adult care. Strategies to promote a tailored support for patients with LD should be sought, and earlier engagement should be encouraged to minimize follow-up losses

Comparison of ultrasound-derived muscle thickness with computed tomography muscle cross-sectional area on admission to the intensive care unit : A pilot cross-sectional study

Introduction The development of bedside methods to assess muscularity is an essential critical care nutrition research priority. We aimed to compare ultrasound-derived muscle thickness at 5 landmarks with computed tomography (CT) muscle area at intensive care unit (ICU) admission. Secondary aims were to (1) combine muscle thicknesses and baseline covariates to evaluate correlation with CT muscle area and (2) assess the ability of the best-performing ultrasound model to identify patients with low CT muscle area. Methods Adult patients who underwent CT scanning at the third lumbar area <72 hours after ICU admission were prospectively recruited. Muscle thickness was measured at mid-upper arm, forearm, abdomen, and thighs. Low CT muscle area was determined using published cutoffs. Pearson correlation compared ultrasound-derived muscle thickness and CT muscle area. Linear regression was used to develop ultrasound prediction models. Bland-Altman analyses compared ultrasound-predicted and CT-measured muscle area. Results Fifty ICU patients were enrolled, aged 52 ± 20 years. Ultrasound-derived muscle thickness at each landmark correlated with CT muscle area (P < .001). The sum of muscle thickness at mid-upper arm and bilateral thighs, including age, sex, and the Charlson Comorbidity Index, improved the correlation with CT muscle area (r = 0.85; P < .001). Mean difference between ultrasound-predicted and CT-measured muscle area was −2 cm2 (95% limits of agreement, −40 cm2 to +36 cm2). The best-performing ultrasound model demonstrated good ability to identify 14 patients with low CT muscle area (area under curve = 0.79). Conclusion Ultrasound shows potential for assessing muscularity at ICU admission (Clinicaltrials.gov NCT03019913)

The Exploration of Solution Options in Design: A ‘Naturalistic Decision Making’ Perspective.

This paper examines how a ‘naturalistic decision making’ (NDM) approach to understanding cognitive processing in complex, real-world environments may facilitate an improved theoretical interpretation of solution-generation and solution-evaluation in design. In reviewing research that has investigated solution exploration in design, we contrast studies of individual designers with studies of team-based activity. We propose that both individual and collaborative design is based around the application of a dominant satisficing approach to solution exploration, and we discuss how the satisficing that is seen in design situations mirrors decision-making strategies observed in a wide range of NDM contexts. In line with the NDM framework, we argue for a view of satisficing as being adaptive and efficient in ill-defined and dynamic contexts such as professional design. We conclude with an overview of the prospects for an NDM account of design, focusing particularly on avenues for future studies of the solution-exploration processes that underpin design expertise in collaborative contexts

The Exploration of Solution Options in Design: A ‘Natural Decision Making’ Perspective

This paper examines how a ‘naturalistic decision making ’ (NDM) approach to understanding cognitive processing in complex, real-world environments may facilitate an improved theoretical interpretation of solution-generation and solution-evaluation in design. In reviewing research that has investigated solution exploration in design, we contrast studies of individual designers with studies of team-based activity. We propose that both individual and collaborative design is based around the application of a dominant satisficing approach to solution exploration, and we discuss how the satisficing that is seen in design situations mirrors decision-making strategies observed in a wide range of NDM contexts. We argue for a view of satisficing as being adaptive and efficient in ill-defined and dynamic contexts such as professional design. We conclude with an overview of the prospects for an NDM account of design, focusing particularly on avenues for future studies of the solutionexploration processes that underpin design expertise in collaborative contexts. Design activity is often viewed as a form of problem solving (e.g.