Background Aerosolized medications are frequently administered through nebulization to treat respiratory conditions. Vibrating mesh nebulizers (VMN) are preferred over junction emission technology (JET) nebulizers (JN) in providing effective treatment. They potentially differ in environmental impact due to differences in product and medicine waste. Aim To quantify waste related to nebulization by JN and VMN to determine the most sustainable nebulization option in the ICU. Methods A waste audit was performed in the ICU of Erasmus University Medical Center, Rotterdam, The Netherlands. The functional unit was product waste per nebulization, cumulative waste generated by nebulization over nine days and product waste in one year. Waste of two JN and two VMN was quantified, including packaging and administration products. Nebulization was simulated to determine medication waste per nebulizer. Total amount of waste was calculated per nebulization and extrapolated for the year 2023. Results Overall, JN generated more waste than VMN. VMN in non-mechanically ventilated patients without tracheostomy generated more waste compared to JN on day one. Use beyond one day resulted in more waste for JN compared to VMN, related to product waste. Additionally, medication waste differed between JN (median of 0.60 mL) and VMN (median of 0.06 mL). Based on 2230 nebulizations in the ICU in 2023, JN produced 91,1 kg of waste and VMN produced 35,4 kg of waste. Conclusion Nebulization with VMN generated less product and medication waste than JN in the ICU. VMN may therefore be a more sustainable option for treating acute respiratory conditions in the ICU.
Purpose To determine whether early radiographic trajectory data can predict the timing of stability in conservatively managed distal radius fractures (DRFs) and to identify which clinical and radiographic features most influence stabilization timing. Methods This retrospective cohort study analyzed data from 1,585 adult patients with conservatively managed DRFs collected from a single-institution fracture registry (2020−2024). Radiographic stability was classified according to predefined parameters of radial height, volar tilt, radial inclination, and ulnar variance at weekly follow-ups. An explainable machine learning model incorporating demographics, fracture characteristics, comorbidities, and early radiographic changes was developed to predict stability at various weeks. Predictive performance was evaluated using area under the receiver operating characteristic curve, calibration plots, Brier scores, decision curve analysis, and SHapley Additive exPlanations. Results Among 1,585 patients, 40% of fractures achieved radiographic stability by week 3. Baseline radiographic measurements did not differ across stability groups, but first-week displacement differed significantly across all parameters. A combined model incorporating early radiographic changes substantially outperformed a baseline-only model. Decision curve analysis demonstrated a superior net benefit compared with routine imaging strategies. SHapley Additive exPlanations analysis identified early changes in volar tilt as the single most influential predictor, followed by changes in radial inclination, patient age, and dorsal comminution. Conclusions Early radiographic trajectory, particularly first-week changes in volar tilt, predicts the timing of stability far more accurately than baseline features alone. A substantial proportion of conservatively managed DRFs stabilize earlier than conventional protocols assume, suggesting that a trajectory-guided approach could safely reduce late follow-up imaging and immobilization duration in selected patients. Prospective validation is needed before clinical implementation. Clinical relevance First-week radiographic displacement, particularly changes in volar tilt, may be more informative than traditional baseline instability criteria for guiding follow-up frequency and immobilization duration in conservatively managed DRFs. Level of evidence Prognostic/III.
The 16th Acromegaly Consensus Conference in September 2024 updated recommendations on diagnosis and treatment of acromegaly comorbidities. Since the 2020 acromegaly comorbidity management guideline was published, new evidence has emerged on novel and known comorbidities and new treatment approaches. Forty-three experts in the management of acromegaly reviewed the current literature and assessed changes in clinical practice standards and management. Current outcome goals were considered and updated, with a focus on the impact of current and emerging treatments of these comorbidities. Participants assessed factors that determine pharmacological choices, as well as use of specific agents in the management of the most relevant acromegaly comorbidities. We present consensus recommendations highlighting optimization of evidence-based acromegaly comorbidities management.
The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) presents significant challenges, underscoring the need for improved transitional care procedures. Few European countries have implemented national transition-related guidance, despite the potential of clinical guidance to support appropriate care decisions and practices. We conducted a literature review to inform the development of the European Society of Child and Adolescent Psychiatry (ESCAP) transition guidance for clinicians. Following systematic principles, four databases (Medline, Embase, PsychInfo, Web of Science) were searched to identify relevant international research published from January 1, 2019 to April 10, 2025, to build on existing evidence. Titles and abstracts were reviewed by two independent reviewers. We screened 12,595 records and included 149 reports published since 2019. Illness severity was the primary predictor of AMHS transition, with only 20–25
Previous studies have suggested that prenatal maternal folate deficiency is associated with reduced prenatal brain growth and psychological problems in offspring. However, little is known about the longer-term impact. The aims of this study were to investigate whether prenatal maternal folate insufficiency, high total homocysteine levels and low vitamin B12 levels are associated with altered brain morphology, cognitive and/or psychological problems in school-aged children. This study was embedded in Generation R, a prospective population-based cohort study. The study sample consisted of 256 Dutch children aged between 6 and 8 years from whom structural brain scans were collected using MRI. The mothers of sixty-two children had insufficient (<8 nmol/l) plasma folate concentrations in early pregnancy. Cognitive development was assessed by the Snijders-Oomen Niet-verbale intelligentietest - Revisie and the NEPSY-II-NL. Psychological problems were assessed at age 6 years using the parent report of the Child Behavior Checklist. Low prenatal folate levels were associated with a smaller total brain volume (B -33·34; 95 % CI -66·7, 0·02; P=050) and predicted poorer performance on the language (B -0·28; 95 % CI -0·52, -0·04; P=0·020) and visuo-spatial domains (B -0·27; 95 % CI -0·50, -0·04; P=0·021). High homocysteine levels (>9·1 µmol/l) predicted poorer performance on the language (B -0·31; 95 % CI -0·56, -0·06; P=0·014) and visuo-spatial domains (B -0·36; 95 % CI -0·60, -0·11; P=0·004). No associations with psychological problems were found. Our findings suggest that folate insufficiency in early pregnancy has a long-lasting, global effect on brain development and is, together with homocysteine levels, associated with poorer cognitive performance.
