PURPOSE: The objectives of this review are to summarize the current practices and major recent advances in critical care nutrition and metabolism, review common beliefs that have been contradicted by recent trials, highlight key remaining areas of uncertainty, and suggest recommendations for the top 10 studies/trials to be done in the next 10 years.METHODS: Recent literature was reviewed and developments and knowledge gaps were summarized. The panel identified candidate topics for future trials in critical care nutrition and metabolism. Then, members of the panel rated each one of the topics using a grading system (0-4). Potential studies were ranked on the basis of average score.RESULTS: Recent randomized controlled trials (RCTs) have challenged several concepts, including the notion that energy expenditure must be met universally in all critically ill patients during the acute phase of critical illness, the routine monitoring of gastric residual volume, and the value of immune-modulating nutrition. The optimal protein dose combined with standardized active and passive mobilization during the acute phase and post-acute phase of critical illness were the top ranked studies for the next 10 years. Nutritional assessment, nutritional strategies in critically obese patients, and the effects of continuous versus intermittent enteral nutrition were also among the highest-ranking studies.CONCLUSIONS: Priorities for clinical research in the field of nutritional management of critically ill patients were suggested, with the prospect that different nutritional interventions targeted to the appropriate patient population will be examined for their effect on facilitating recovery and improving survival in adequately powered and properly designed studies, probably in conjunction with physical activity.
The high prevalence and burden of cardiovascular diseases (CVD) is largely attributable to unhealthy lifestyle factors such as smoking, alcohol consumption, physical inactivity and unhealthy food habits. Prevention of CVD, through the promotion of healthy lifestyles, appears to be a Sisyphean task for healthcare professionals, as the root causes of an unhealthy lifestyle lie largely outside their scope. Since most lifestyle choices are habitual and a response to environmental cues, rather than rational and deliberate choices, nationwide policies targeting the context in which lifestyle behaviours occur may be highly effective in the prevention of CVD. In this point-of-view article, we emphasise the need for government policies beyond those mentioned in the National Prevention Agreement in the Netherlands to effectively reduce the CVD risk, and we address the commonly raised concerns regarding ‘paternalism’.
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This paper presents the results of a survey which aimed at exploring the perceptions of the employees of a large aviation organization regarding the punitive or preventive character of possible measures that management could take in cases of errors and violations. The analysis of the quantitative and qualitative data collected showed that the viewpoints of the staff were sufficiently aligned only for half of the measures and that all measures inflicting a short- or long-term dissociation of the end-users from their current working place and function were highly unfavourable and linked to castigation. Also, statistically significant differences were observed across groups of specialties and years of service regarding the appropriateness of specific measures especially in the case of errors. The findings of this study in combination with literature references, suggest that the establishment of a just culture structure with agreed lines between the punitive and preventive character of measures and its endorsement by the employees is achievable, but it requires a bottom-up approach and periodical revision. Similar exploratory research, complemented possibly by explanatory studies, is recommended to be carried out by organizations prior or during the development of their just culture policy andrelated measures.
The continuous monitoring of health indicators in biofluids such as sweat, saliva, blood, and urine has great potential for preventive medicine. Techniques that continuously monitor biomarkers still remain a major technological challenge. Recently, a concept of dynamic biosensing was published that is based on mediator particles. Such mediator particles exhibit rapid switching between a bound and unbound state during interaction with a probing structure to which they are connected through a molecular tether (like a balloon on a string). Although the concept of using mediator particles for dynamics biosensing is very promising, the used detection method is not a viable solution as it is not miniaturizable. We propose to use a photonic ring resonator (RR) or Mach-Zender interferometer (MZI) as the probing structure in combination with a highly miniaturizable readout scheme. In this project, we perform preliminary experiments to prove that this photonic approach can be used for the detection of the mediator particles tethered to the photonic waveguide. To bridge the gap with the practical application by health professionals, we will enrich the envisioned solution through OnePlanet's OpenEd program. OpenEd aims to share technology and innovations (e.g. prototypes) with educational institutes (MBO, HBO) that want to further innovate their courses or work methods, such that current and future professionals are well prepared to work with new (digital) technologies. By presenting our use-case as a 'challenge' to teachers, students and practitioners, OpenEd also allows enriching the use-case by involving (future) health professionals that can provide feedback on - or further investigation of - the practical application of our new technology from the health professional's perspective.
