Predicting hypercapnia and hypoxia by the ventilator's built-in software in children on long-term non-invasive ventilation: A pilot study

IntroductionFollow-up of children on long-term non-invasive ventilation (NIV) could be improved by telemonitoring, using the ventilator's built-in software (BIS) parameters as alternative for in-hospital sleep studies to reduce costs, enhance patient independence and contribute to early detection of infections. This pilot study investigated whether analysis of BIS parameters can predict abnormal nocturnal transcutaneous CO2 (TcCO2) and saturation (SpO2) measurements in children on long-term NIV.MethodsChildren on long-term NIV in follow-up at the Antwerp University Hospital were retrospectively included. Nocturnal TcCO2 and SpO2 measurements were collected together with BIS parameters at three different time points: the night of the sleep study (BIS1), mean values from 48 h (BIS2) and 72 h (BIS3) before the sleep study. Predictions were calculated for following outcome measures: % recording time TcCO2 > 46.9 mmHg (%RT TcCO2; abnormal if ≥2%), recording time SpO2 < 93% (RT SpO2; abnormal if >1 h), abnormal TcCO2 or SpO2, mean TcCO2, mean SpO2.Results69 patients were included. %RT TcCO2 was separately predicted by reached tidal volume2 [OR 0.97 (0.93; 1.00); p = 0.051; AUC = 30%] and reached IPAP1 [OR 1.05 (1.00; 1.10); p = 0.050; AUC = 66%]. Leak1 predicted RT SpO2 [OR 1.21 (1.02; 1.43); p = 0.025; AUC = 84%]. Mean TcCO2 correlated with reached tidal volume2 (R2 0.10, p = 0.033).DiscussionCertain BIS parameters can predict nocturnal hypercapnia and desaturation in children on long-term NIV. Future studies with larger sample sizes are warranted to further investigate the predictive value of the identified BIS parameters

Quality assurance of rectal cancer diagnosis and treatment - phase 3 : statistical methods to benchmark centres on a set of quality indicators

In 2004, the Belgian Section for Colorectal Surgery, a section of the Royal Belgian Society for Surgery, decided to start PROCARE (PROject on CAncer of the REctum), a multidisciplinary, profession-driven and decentralized project with as main objectives the reduction of diagnostic and therapeutic variability and improvement of outcome in patients with rectal cancer. All medical specialties involved in the care of rectal cancer established a multidisciplinary steering group in 2005. They agreed to approach the stated goal by means of treatment standardization through guidelines, implementation of these guidelines and quality assurance through registration and feedback. In 2007, the PROCARE guidelines were updated (Procare Phase I, KCE report 69). In 2008, a set of 40 process and outcome quality of care indicators (QCI) was developed and organized into 8 domains of care: general, diagnosis/staging, neoadjuvant treatment, surgery, adjuvant treatment, palliative treatment, follow-up and histopathologic examination. These QCIs were tested on the prospective PROCARE database and on an administrative (claims) database (Procare Phase II, KCE report 81). Afterwards, 4 QCIs were added by the PROCARE group. Centres have been receiving feedback from the PROCARE registry on these QCIs with a description of the distribution of the unadjusted centre-averaged observed measures and the centre’s position therein. To optimize this feedback, centres should ideally be informed of their risk-adjusted outcomes and be given some benchmarks. The PROCARE Phase III study is devoted to developing a methodology to achieve this feedback

Understanding smallholder farmers' intention to adopt agricultural apps : the role of mastery approach and innovation hubs in mexico

While several studies have focused on the actual adoption of agricultural apps and the relevance of the apps’ content, very few studies have focused on drivers of the farmer’s intention and initial decision to adopt. Based on a survey of 394 smallholder farmers in 2019, this study investigated willingness to adopt an agricultural advice app in Guanajuato, Mexico. A structural equation modeling approach, based on the unified theory of acceptance and use of technology (UTAUT), was applied. To understand the farmers’ adoption decisions, extended constructs were studied (e.g., mastery-approach goals) along with the farmers’ age and participation in an innovation hub. Results showed that the intention to adopt the app is predicted by how farmers appraise the technical infrastructure and acquire new knowledge by using an app. The multi-group analysis revealed that performance expectancy is a relevant predictor of the intention to adopt, whereas the mastery-approach goal is relevant only for younger farmers and farmers not connected to the innovation hub. This study provides valuable insights about the innovation hubs’ role in the intention to adopt apps, offering precision agriculture advice in developing countries. The findings are useful for practitioners and app developers designing digital-decision support tools

Breathing across ages: a systematic review on challenges and components of transitional care for young people with asthma

IntroductionAsthma is a chronic condition that affects millions of adolescents and young adults (AYA) worldwide. The transition from pediatric to adult care presents unique challenges for this population, affecting their self-management, quality of life and overall health outcomes. This systematic review aims to consolidate the available evidence on challenges encountered by AYA with asthma during the transition period from child to AYA and on the key elements of transitional care for AYAs with asthma including the outcomes achieved, ultimately enhancing outcomes.MethodologyA systematic literature search was performed in PubMed, Embase, Medline, Scopus, and Web of Science from their inception to October 2, 2023, to provide an overview of currently available literature. Primary quantitative and qualitative studies, published in peer-reviewed journals that focused on AYA with a confirmed diagnosis of asthma were considered if they focused on challenges encountered by AYA with asthma during the transition process and/or components of transitional care and their outcomes assessed.ResultsA total of 855 studies were initially identified and 6 articles were included in this systematic literature review. Several challenges experienced by AYA with asthma were identified including maintaining medication adherence, the need to take responsibility and being involved, understanding their condition and its severity, feeling left out of the care system, and experiencing a lack of engagement. The identified transitional care components included a standardized form for medical data transmission, a joint consultation and to offer several longer consultations.ConclusionSeveral international guidelines for asthma care recommend implementing transition programs in the care for AYA with asthma. Such transition programs should include a comprehensive and individualized approach addressing several challenges faced, to ensure optimal outcomes post-transition. However, to date, data on effective components of transitional care facilitating good outcomes were found to be limited. This systematic review underscores the need for larger studies evaluating the effect of the components of transition programs

WELCOME : improving WEight controL and CO-Morbidities in children with obesity via Executive function training : study protocol for a randomized controlled trial

Background: Obesity is a widespread problem that not only leads to medical and psychological diseases in adults, but also in children and adolescents at an early stage in life. Because of its global burden on both the individual and society, it is necessary to develop effective evidence-based treatments. Current " Multidisciplinary Obesity Treatments" (MOT) already provide significant weight loss, but still leave room for more long-lasting improvements. In this protocol paper, we outline the research goals of the WELCOME trial, based on a substantial proof of concept. Methods: In this Randomized Controlled Trial (RCT) - conducted in both an inpatient and two outpatient treatment settings -existing MOT will be supplemented with an Executive Function (EF) training and compare effects on various parameters in an experimental versus an active control group of obese youngsters (8-18 years old). WELCOME aims to (a) train youngsters' executive functions to facilitate effects on weight loss, psychological and medical comorbidities, (b) to enhance the long-term effects by continuing the training in the daily home context with booster sessions, and (c) to investigate its effects until a 6-month follow-up. In comparison to the active control group, better progress is expected in the experimental group on following variables: weight, psychological comorbidities (unhealthy eating behavior, internalizing symptoms, impaired self-esteem) and medical comorbidities (metabolic syndromes, endothelia dysfunction, tonsillar hypertrophy and sleep obstruction). Discussion: It is stated that this EF-training for enhancing self-control abilities is necessary for a long-lasting effect of childhood obesity treatment interventions