Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care

Advance care planning (ACP) is increasingly implemented in oncology and beyond, but a definition of ACP and recommendations concerning its use are lacking. We used a formal Delphi consensus process to help develop a definition of ACP and provide recommendations for its application. Of the 109 experts (82 from Europe, 16 from North America, and 11 from Australia) who rated the ACP definitions and its 41 recommendations, agreement for each definition or recommendation was between 68–100%. ACP was defined as the ability to enable individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and health-care providers, and to record and review these preferences if appropriate. Recommendations included the adaptation of ACP based on the readiness of the individual; targeting ACP content as the individual's health condition worsens; and, using trained non-physician facilitators to support the ACP process. We present a list of outcome measures to enable the pooling and comparison of results of ACP studies. We believe that our recommendations can provide guidance for clinical practice, ACP policy, and research

Ventilation and outcomes following robotic-assisted abdominal surgery: an international, multicentre observational study

Background: International data on the epidemiology, ventilation practice, and outcomes in patients undergoing abdominal robotic-assisted surgery (RAS) are lacking. The aim of the study was to assess the incidence of postoperative pulmonary complications (PPCs), and to describe ventilator management after abdominal RAS. Methods: This was an international, multicentre, prospective study in 34 centres in nine countries. Patients ≥18 yr of age undergoing abdominal RAS were enrolled between April 2017 and March 2019. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score was used to stratify for higher risk of PPCs (≥26). The primary outcome was the incidence of PPCs. Secondary endpoints included the preoperative risk for PPCs and ventilator management. Results: Of 1167 subjects screened, 905 abdominal RAS patients were included. Overall, 590 (65.2%) patients were at increased risk for PPCs. Meanwhile, 172 (19%) patients sustained PPCs, which occurred more frequently in 132 (22.4%) patients at increased risk, compared with 40 (12.7%) patients at lower risk of PPCs (absolute risk difference: 12.2% [95% confidence intervals (CI), 6.8–17.6%]; P<0.001). Plateau and driving pressures were higher in patients at increased risk, compared with patients at low risk of PPCs, but no ventilatory variables were independently associated with increased occurrence of PPCs. Development of PPCs was associated with a longer hospital stay. Conclusions: One in five patients developed one or more PPCs (chiefly unplanned oxygen requirement), which was associated with a longer hospital stay. No ventilatory variables were independently associated with PPCs. Clinical trial registration: NCT02989415

Nocturnal seizure detection:What are the needs and expectations of adults with epilepsy receiving secondary care?

Introduction: Seizure detection devices (SDDs) may lower the risk of sudden unexpected death in epilepsy (SUDEP) and provide reassurance to people with epilepsy and their relatives. We aimed to explore the perspectives of those receiving secondary care on nocturnal SDDs and epilepsy in general. Materials and methods: We recruited adults with tonic or tonic-clonic seizures who had at least one nocturnal seizure in the preceding year. We used semi-structured interviews and questionnaires to explore their views on SDDs and their experiences of living with epilepsy. None of the participants had any previous experience with SDDs. We analyzed the data using qualitative content analysis. Results: Eleven participants were included with a nocturnal seizure frequency ranging from once every few weeks to less than once a year. Some participants experienced little burden of disease, whereas others were extremely impaired. Opinions on the perceived benefit of seizure detection varied widely and did not always match the clinical profile. Some participants with high SUDEP risk displayed no interest at all, whereas others with a low risk for unattended seizures displayed a strong interest. Reasons for wanting to use SDDs included providing reassurance, SUDEP prevention, and improving night rest. Reasons for not wanting to use SDDs included not being able to afford it, having to deal with false alarms, not having anyone to act upon the alarms, having a relative that will notice any seizures, not feeling like the epilepsy is severe enough to warrant SDD usage or not trusting the device. Conclusions: The interest in nocturnal seizure detection varies among participants with low seizure frequencies and does not always match the added value one would expect based on the clinical profile. Further developments should account for the heterogeneity in user groups.</p

Le cidre, d’une logique de l’offre vers une démarche marketing de la demande

Textes issus des travaux du programme Casdar "Innovation et Partenariat" de 2007 et présentés lors d'un colloque le 4 décembre 2012, sous l'égide du GIS Relance AgronomiqueBetter understanding consumers' expectations as regards ciders and building on the latest contributions of research are essential in order to meet expectations. This project was carried out from 2008 to 2011 under the lead of the Chambre régionale d’agriculture de Normandie. This work involved various partners among which IFPC, ESA Angers, INRA (Centre des sciences du goût et de l'alimentation and Unité de recherche cidricole), Laboratoire Frank Duncombe, ADRIA-Normandie and technicians from the cider industry. Results of this study (consumer panel and organoleptic preference mapping) have highlighted different cider consumer profiles. . It has also been demonstrated that sweet, fruity ciders with low bitterness and low astringency are preferred by a large majority of consumers. The recent research works conducted by the UMT Novacidre (a mixed unit formed by IFPC and INRA Unité de recherche cidricole de l’INRA du Rheu), have led to propose a range of management tools for cider-making in order to modulate the sensory profile of ciders. These tools, prospective or already existing, are efficient in terms of impact on the finished produce, both in the aromatic field with an increase of fruitiness and in terms of flavors, as they allow, for example, reduction of astringency, often rejected by consumers, without changing perception of bitterness which contributes to the produce structure.Cette étude a été menée de 2008 à 2011 à l’échelle de la filière par la Chambre régionale d’agriculture de Normandie, en partenariat avec notamment l’IFPC, l’ESA d’Angers, l’INRA (Centre des sciences du goût et de l'alimentation, Unité de recherche cidricole), le laboratoire Frank Duncombe, l’ADRIANormandie et les techniciens de la filière. Ce travail d’analyse et de cartographie des préférences organoleptiques des cidres du marché, par un panel de consommateurs, a mis en lumière différents profils de consommateurs. Il a ainsi été mis en évidence que les cidres orientés vers un équilibre sucré, peu amer, peu astringent et révélant un fruité important sont majoritairement préférés. Les acquis récents obtenus à l’UMT Cidricole, constituée par l’IFPC et l’Unité de recherche cidricole de l’INRA du Rheu, permettent de disposer d’une palette d’outils de pilotage des fabrications capables de moduler le profil sensoriel des cidres. Ces outils, pressentis ou déjà existants, sont puissants en terme d’impact sur le produit fini, aussi bien sur le plan aromatique par une augmentation du fruité que sur le plan des saveurs où ils permettent, par exemple, de diminuer l’astringence, souvent rejetée par les consommateurs, sans modifier la perception de l’amertume, responsable du corps du produit