Nutritional follow-up in children after discharge: Organisation in a tertiary care centre.

BACKGROUND: Aiming to improve the standard of care for patients with a nutritional intervention, we evaluated how nutritional follow-up (FU) is organised at discharge and after 6 months. METHODS: From 16 November 2020 until 20 December 2020, we retrospectively included patients admitted for > 1 day to the general ward of a tertiary hospital. Medical charts were reviewed for demographics, anthropometric measurements and nutritional interventions (e.g., tube, parenteral nutrition). Involved healthcare provider (HCP), dietitian and speech and language therapist (SLT) were scored. Nutritional care FU was categorised as in a primary, secondary or tertiary care setting. RESULTS: We included 206 (52.4% male) patients, with a median length of stay of 4 (3-8) days. Prehospitalisation 58 (28.2%) patients had a nutritional intervention compared to 74 (35.9%) patients at discharge. In total, 80 (38.8%) patients received nutritional care FU by a total of 114 HCP, and approximately half (53.5%) were dietitians. FU was mostly conducted by a dietitian in the tertiary care (78.7%) and by an SLT in the primary care (54.5%). For 15 (20.3%) patients, the discharge letter included complete reports of nutritional interventions. At 6 months FU, 26.6% of the children still had a nutritional intervention. Mean weight standard deviation score increased significantly between discharge from the hospital and 6 months FU. CONCLUSIONS: A considerable amount of paediatric patients received a nutritional intervention pre- and post-hospitalisation. Nutritional care is organised around a multitude of different HCP; however, not all cases are multidisciplinary. Nutritional care was scarcely reported correctly in the discharge letter.

Pediatric to adult transition care in neurogastroenterology and motility: A position paper from the American Neurogastroenterology and Motility Society and European Society of Neurogastroenterology and Motility.

Transition services-programs that support adolescents and young adults (AYAs) as they move from a child-centered to a more autonomous, adult-orientated healthcare system-have been associated with improved short- and long-term healthcare outcomes. Unfortunately, there is a paucity of evidence exploring transition services within the neurogastroenterology and motility (NGM) field. The overall aim of this article, endorsed by the American Neurogastroenterology and Motility Society and European Society of Neurogastroenterology and Motility, is to promote a discussion about the role of transition services for patients with NGM disorders. The AYAs addressed herein are those who have: (a) a ROME positive disorder of gut-brain interaction (DGBI), (b) a primary or secondary motility disorder (including those with motility disorders that have been surgically managed), or (c) an artificial feeding requirement (parenteral or enteral tube feeding) to manage malnutrition secondary to categories (a) or (b). The issues explored in this position paper include the specific physical and psychological healthcare needs of patients with NGM disorders; key healthcare professionals who should form part of a secondary care NGM transition service; the triadic relationship between healthcare professionals, caregivers, and patients; approaches to selecting patients who may benefit most from transition care; methods to assess transition readiness; and strategies with which to facilitate transfer of care between healthcare professionals. Key areas for future research are also addressed, including the construction of NGM-specific transition readiness questionnaires, tools to assess post-transfer healthcare outcomes, and educational programs to train healthcare professionals about transition care in NGM.

Preliminary Study of the Effects of a Dysphagia Support Group on Quality of Life.

PURPOSE: Dysphagia (swallowing difficulties) can greatly decrease quality of life for individuals with dysphagia and can lead to caregiver burden and third-party disability. Support groups have been shown to be effective in improving quality of life in a range of conditions, through allowing individuals to form connections with those with shared experiences and sharing and learning about relevant resources and coping skills. However, no research on the effects of dysphagia support groups on quality of life has been conducted. This preliminary study aimed to determine whether a virtual support group, facilitated by speech-language pathologists, could positively affect quality of life in similar ways for adults with dysphagia and their family caregivers. METHOD: Pre- and postsupport group surveys were sent to participants to gain information about their dysphagia, demographics, and support group feedback (e.g., access to resources). Questions were mainly multiple choice, with three open-ended questions related to the support group. RESULTS: Eight individuals participated in the surveys, with four completing both pre- and postsession surveys. Seven of eight individuals reported that they felt a support group could improve their quality of life, with the eighth being unsure. Qualitative data found the support group offered both informational (e.g., resource access) and psychosocial support (e.g., knowledge that they were not alone, emotional support). CONCLUSION: These initial results suggest that a dysphagia support group could fill a gap in the health care system to offer more holistic support to individuals with dysphagia and their family caregivers.

Resting Energy Expenditure and Body Composition in Children and Adolescents With Genetic, Hypothalamic, Medication-Induced or Multifactorial Severe Obesity.

Background: Pediatric obesity is a multifactorial disease which can be caused by underlying medical disorders arising from disruptions in the hypothalamic leptin-melanocortin pathway, which regulates satiety and energy expenditure. Aim: To investigate and compare resting energy expenditure (REE) and body composition characteristics of children and adolescents with severe obesity with or without underlying medical causes. Methods: This prospective observational study included pediatric patients who underwent an extensive diagnostic workup in our academic centre that evaluated endocrine, non-syndromic and syndromic genetic, hypothalamic, and medication-induced causes of obesity. REE was assessed by indirect calorimetry; body composition by air displacement plethysmography. The ratio between measured REE (mREE) and predicted REE (Schofield equations), REE%, was calculated, with decreased mREE defined as REE% ≤90% and elevated mREE ≥110%. Additionally, the influence of fat-free-mass (FFM) on mREE was evaluated using multiple linear regression. Results: We included 292 patients (146 [50%] with body composition measurements), of which 218 (75%) patients had multifactorial obesity and 74 (25%) an underlying medical cause: non-syndromic and syndromic genetic (n= 29 and 28, respectively), hypothalamic (n= 10), and medication-induced (n= 7) obesity. Mean age was 10.8 ± 4.3 years, 59% were female, mean BMI SDS was 3.8 ± 1.1, indicating severe obesity. Mean REE% was higher in children with non-syndromic genetic obesity (107.4% ± 12.7) and lower in children with hypothalamic obesity (87.6% ± 14.2) compared to multifactorial obesity (100.5% ± 12.6, both p<0.01). In 9 children with pseudohypoparathyroidism type 1a, mean REE% was similar (100.4 ± 5.1). Across all patients, mREE was decreased in 60 (21%) patients and elevated in 69 (24%) patients. After adjustment for FFM, mREE did not differ between patients within each of the subgroups of underlying medical causes compared to multifactorial obesity (all p>0.05). Conclusions: In this cohort of children with severe obesity due to various etiologies, large inter-individual differences in mREE were found. Consistent with previous studies, almost half of patients had decreased or elevated mREE. This knowledge is important for patient-tailored treatment, e.g. personalized dietary and physical activity interventions and consideration of pharmacotherapy affecting central energy expenditure regulation in children with decreased mREE.

Solid-State Infrared Upconversion in Perylene Diimides Followed by Direct Electron Injection.

In this contribution we demonstrate a solid-state approach to triplet-triplet annihilation upconversion for application in a solar cell device in which absorption of near-infrared light is followed by direct electron injection into an inorganic substrate. We use time-resolved microwave photoconductivity experiments to study the injection of electrons into the electron-accepting substrate (TiO2) in a trilayer device consisting of a triplet sensitizer (fluorinated zinc phthalocyanine), triplet acceptor (methyl subsituted perylenediimide), and smooth polycrystalline TiO2. Absorption of light at 700 nm leads to the almost quantitative generation of triplet excited states by intersystem crossing. This is followed by Dexter energy transfer to the triplet acceptor layer where triplet annihilation occurs and concludes by injection of an electron into TiO2 from the upconverted singlet excited state.

Imaging and nanofabrication with the helium ion microscope of the Van Leeuwenhoek Laboratory in Delft.

Although helium ion microscopy (HIM) was introduced only a few years ago, many new application fields are emerging. The connecting factor between these novel applications is the unique interaction of the primary helium ion beam with the sample material at and just below its surface. In particular, the HIM secondary electron signal stems from an area that is extremely well localized around the point of incidence of the primary beam. This makes the HIM well suited for both high-resolution imaging and high-resolution nanofabrication. Another advantage in nanofabrication is the low ion backscattering fraction, which leads to a weak proximity effect. The subnanometer probe size and the unique beam-materials interactions have opened new areas of research. This review presents a selection of studies conducted on a single instrument. The selection encompasses applications ranging from imaging to nanofabrication and from fundamental academic research to applied industrial developments.