Cees P. van der Schans

Purpose: To timely tackle malnutrition in hospital patients, the implementation of a new malnutrition practice is needed. We aimed to determine the readiness of nutrition support hospital staff for implementing a new malnutrition practice, using the Patient-Generated Subjective Global Assessment (PG-SGA) instrument. Participants and Methods: A cross-sectional assessment of readiness among nutrition support hospital staff was conducted using semi-structured interviews. Interviews were scored across five dimensions of the community readiness model: Knowledge of efforts, Leadership, Community climate, Knowledge of the issue, and Resources for efforts. A general score and a dimension score (mean and standard deviation) were calculated. Scores could range from 1 (no awareness) to 9 (community ownership). Results: In total, 11 respondents, including physicians (n=2), dietitian (n=1), physiotherapists (n=3), speech therapists (n=2), nutritional assistants (n=2), and a manager (n=1) were interviewed. The general community readiness score was 4.0± 0.3, indicating the preplanning stage for the implementation of the PG-SGA. All five dimensions were in the preplanning range (3.5– 4.5). Resources was lowest (3.5 ± 0.9; range 3.0– 4.0), and Knowledge of efforts was highest (4.5 ± 1.9; range 2.0– 7.0); the scores of the remaining dimensions clustered around ~4.0. No dimension score exceeded the preplanning stage. Conclusion: Readiness to implement the PG-SGA was uniformly low (ie, at preplanning stage) across CRM dimensions, with resources most limited and awareness of existing efforts highest, yet still in the preplanning stage. Recommendations are directed to hospital leadership/clinical leaders and to interprofessional nutrition teams, with targeted training for all professionals involved in nutritional care to enable progression toward implementation.

Background: Facilitating adult sibling involvement for individuals with pervasive support needs is important. This study explores the attitudes of healthcare professionals in this process. Method: The attitudes of healthcare professionals ( n = 60) in the Netherlands were explored through an online, self‐developed survey with open and closed‐ended questions. Results: Around 40% of the participants reported (partly) lacking knowledge about sibling preferences and 23% (partly) lacking practical opportunities for involving siblings. The majority (partly) perceived the involvement of siblings as an enjoyable part of their work (82%), rated their knowledge and skills positively (87%), and regarded sibling involvement as such importance that they would be willing to exert considerable effort to contribute to it (61%). Not all participants perceived it as their job to collaborate with siblings. Conclusions: There is a need to increase healthcare professionals' knowledge about adult sibling preferences and structurally embed sibling involvement within care practices.

Objectives: This study aims to explore the identification of older people in need of dental consultation, with a Simplified Oral Indicator (SOI) used by home care nurses (HCNs) and with the Geriatric Oral Health Assessment Index (GOHAI-NL) completed by older people themselves, compared with the Oral Health Assessment Tool (OHAT-NL), performed by dental hygienists. Methods: The HCNs completed SOI based on their professional view, knowledge and experience; scores red/orange/green were given to older people for oral health and oral hygiene. Older people completed the GOHAI-NL and dental hygienists completed the OHAT-NL. Results: Data from 141 older people were analysed. Sensitivity and specificity of SOI –OHAT-NL were low (0.45 and 0.64, respectively); SOI scored only few older people as ‘red’, while only 11 older people did not need a dental referral according to the OHAT-NL. OHAT-NL and GOHAI-NL correlation was significant, but low (r = -0.226, p = 0.012). Conclusion: Simplified Oral Indicator is currently not sensitive enough to identify older people in need of dental consultation. Additional education to HCNs and/or adjusting SOI may be needed. The GOHAI-NL seems not useful in dental triage.

Background: For families with adolescent children, the transition to adulthood is usually challenging. This period may be extra demanding for families with a child with profound intellectual and multiple disabilities due to the child's strong and persistent support needs. To support these families during this phase and to facilitate the transition process of these adolescents, we adapted the Canadian skills for growing up (SGU) into the skills for growing up‐profound intellectual and multiple disabilities (SGU‐PIMD). The aim of this study is to determine its content validity.Method: A Delphi study with family members and healthcare professionals was conducted.Results: Results showed good content validity. However, the Delphi panel suggested minor adjustments to improve relevance, comprehensibility and comprehensiveness.Conclusions: The current SGU‐PIMD can be used in practice for supporting adolescents with profound intellectual and multiple disabilities. However, there are also recommendations for research into the feasibility and acceptability of the instrument.

The aim of this study was to develop and validate an algorithm that can identify the type, frequency, and duration of activities common to intensive care (IC) patients. Ten healthy participants wore two accelerometers on their chest and leg while performing 14 activities clustered into four protocols (i.e., natural, strict, healthcare provider, and bed cycling). A video served as the reference standard, with two raters classifying the type and duration of all activities. This classification was reliable as intraclass correlations were all above 0.76 except for walking in the healthcare provider protocol, (0.29). The data of four participants were used to develop and optimize the algorithm by adjusting body-segment angles and rest-activity-threshold values based on percentage agreement (%Agr) with the reference. The validity of the algorithm was subsequently assessed using the data from the remaining six participants. %Agr of the algorithm versus the reference standard regarding lying, sitting activities, and transitions was 95%, 74%, and 80%, respectively, for all protocols except transitions with the help of a healthcare provider, which was 14–18%. For bed cycling, %Agr was 57–76%. This study demonstrated that the developed algorithm is suitable for identifying and quantifying activities common for intensive care patients. Knowledge on the (in)activity of these patients and their impact will optimize mobilization.

The emergence of wearable sensor technology may provide opportunities for automated measurement of psychophysiological markers of mental and physical fitness, which can be used for personalized feedback. This study explores to what extent within-subject changes in resting heart rate variability (HRV) during sleep predict the perceived mental and physical fitness of military personnel on the subsequent morning. Participants wore a Garmin wrist-worn wearable and filled in a short morning questionnaire on their perceived mental and physical fitness during a period of up to 46 days. A custom-built smartphone app was used to directly retrieve heart rate and accelerometer data from the wearable, on which open-source algorithms for sleep detection and artefact filtering were applied. A sample of 571 complete observations in 63 participants were analyzed using linear mixed models. Resting HRV during sleep was a small predictor of perceived physical fitness (marginal R² = .031), but not of mental fitness. The items on perceived mental and physical fitness were strongly correlated (r = .77). Based on the current findings, resting HRV during sleep appears to be more related to the physical component of perceived fitness than its mental component. Recommendations for future studies include improvements in the measurement of sleep and resting HRV, as well as further investigation of the potential impact of resting HRV as a buffer on stress-related outcomes.

Consumer wearables health data may reflect the impact of pancreatic cancer and its treatment on cardiorespiratory fitness and the subsequent recovery after treatment. The patient is a 65-year-old male treated for borderline resectable pancreatic cancer. Treatment consisted of four courses of FOLFIRINOX neoadjuvant chemotherapy, a Whipple procedure with a right hemicolectomy and venous segment resection, and eight courses of adjuvant FOLFIRINOX chemotherapy. Physical activity and moderate to vigorous physical activity declined after the onset of symptoms, increased in the weeks before surgery, declined after surgery and then gradually recovered during and after adjuvant chemotherapy. Estimated VO₂max remained stable during neoadjuvant chemotherapy, sharply decreased after surgery and then gradually recovered. Heart rate at rest increased and heart rate variability decreased after the onset of symptoms reaching their highest and lowest values after surgery. Both gradually returned to baseline seven months after the last course of chemotherapy. The physical impact of pancreatic cancer and its treatment and recovery was in this case reflected on consumer wearable health data. Seven months after the last chemotherapy recovery was close to baseline values.

The effects of stress may be alleviated when its impact or a decreased stress-resilience are detected early. This study explores whether wearable-measured sleep and resting HRV in police officers can be predicted by stress-related Ecological Momentary Assessment (EMA) measures in preceding days and predict stress-related EMA outcomes in subsequent days. Eight police officers used an Oura ring to collect daily Total Sleep Time (TST) and resting Heart Rate Variability (HRV) and an EMA app for measuring demands, stress, mental exhaustion, and vigor during 15–55 weeks. Vector Autoregression (VAR) models were created and complemented by Granger causation tests and Impulse Response Function visualizations. Demands negatively predicted TST and HRV in one participant. TST negatively predicted demands, stress, and mental exhaustion in two, three, and five participants, respectively, and positively predicted vigor in five participants. HRV negatively predicted demands in two participants, and stress and mental exhaustion in one participant. Changes in HRV lasted longer than those in TST. Bidirectional associations of TST and resting HRV with stress-related outcomes were observed at a weak-to-moderate strength, but not consistently across participants. TST and resting HRV are more consistent predictors of stress-resilience in upcoming days than indicators of stress-related measures in prior days.