Western Digital (Netherlands)

<h3>Background and Importance</h3> A survey of market access experts of the Medical Nutrition International Industry was undertaken to understand the barriers contributing to inequity in optimal nutritional care in Europe. <h3>Aim and Objectives</h3> Disease-related malnutrition (DRM), an underdiagnosed, undertreated public health problem that affects 30–50% of hospital inpatients, results in poor health outcomes and higher costs.¹ Multidisciplinary care, including pharmacists, is essential to ensure optimal nutritional interventions.² Pharmacists are vital to multidisciplinary care coordination. Medical nutrition therapy is cost-effective and improves health outcomes, yet inequity exists in access.¹ This survey was conducted to address the limited insight across countries into the major barriers to implementation of equitable nutritional care beyond health technology assessment. <h3>Material and Methods</h3> An online survey was developed by the MNI, and members (n=6) participated between April and December 2024. Additional responses were included (National Industry Groups n=2; additional MNI members n=2). Results covered Croatia, France, Germany, Italy, Poland, Portugal, Spain, Switzerland, The Netherlands and the United Kingdom. Quantitative data were reported as percentages and qualitative data as key themes. <h3>Results</h3> Although screening for DRM was reported as being available in 80% of countries surveyed, it was mandatory in only 20% and often poorly implemented. Knowledge of nutritional care was described as inconsistent and specialty-dependent, with 56% reporting access to expert nutrition professionals as limited to hospital settings. Barriers identified included lack of funding, limited workforce availability and nutrition seen as a low priority. Although reimbursement of food for special medical purposes (FSMP) (medical nutrition products for oral or enteral nutrition) was reported by 90% of country respondents it varied by healthcare setting, and 50% reported that obtaining FSMP is ‘difficult/not easy’. Awareness of DRM amongst patients was reported as low, with difficulties navigating complex healthcare systems citied by 70% of country respondents as a key contributing factor to inequity. <h3>Conclusion and Relevance</h3> Knowledge of system-level barriers to nutritional care, beyond HTA, highlights actionable gaps within hospital practice. Hospital pharmacists can act as drivers of change. Through their roles in therapeutic committees, and care coordination, they can help embed medical nutrition into hospital standards and reduce access inequities. <h3>References and/or Acknowledgements</h3> 1. WHO-ESPEN 2023. https://www.who.int/europe/publications/i/item/WHO-EURO-2023-8931-48703-72392 2. Cederholm, <i>et al</i>. 2017. https://www.ncbi.nlm.nih.gov/pubmed/27642056 <h3>Conflict of Interest</h3> Corporate sponsored research or other substantive relationships: MNI represents the companies that were surveyed for this exercise.

Abdominal aortic aneurysms (AAAs) and peripheral artery disease (PAD) are two vascular diseases with a significant risk of major adverse cardiovascular events and mortality. A challenge in current disease management is the unpredictable disease progression in individual patients. The VASCUL-AID-RETRO study aims to develop trustworthy multimodal predictive artificial intelligence (AI) models for multiple tasks including risk stratification of disease progression and cardiovascular events in patients with AAA and PAD. The VASCUL-AID-RETRO study will collect data from 5000 AAA and 6000 PAD patients across multiple European centers of the VASCUL-AID consortium using electronic health records from 2015 to 2024. This retrospectively-collected data will be enriched with additional data from existing biobanks and registries. Multimodal data, including clinical records, radiological imaging, proteomics, and genomics, will be collected to develop AI models predicting disease progression and cardiovascular risks. This will be done while integrating the international ethics guidelines and legal standards for trustworthy AI, to ensure a socially-responsible data integration and analysis. A consensus-based variable list of clinical parameters and core outcome set for both diseases will be developed through meetings with key opinion leaders. Blood, plasma, and tissue samples from existing biobanks will be analyzed for proteomic and genomic variations. AI models will be trained on segmented AAA and PAD artery geometries for estimation of hemodynamic parameters to quantify disease progression. Initially, risk prediction models will be developed for each modality separately, and subsequently, all data will be combined to be used as input to multimodal prediction models. During all processes, data security, data quality, and ethical guidelines and legal standards will be carefully considered. As a next step, the developed models will be further adjusted with prospective data and internally validated in a prospective cohort (VASCUL-AID-PRO study). The VASCUL-AID-RETRO study will utilize advanced AI techniques and integrate clinical, imaging, and multi-omics data to predict AAA and PAD progression and cardiovascular events. The VASCUL-AID-RETRO study is registered at www.clinicaltrials.gov under the identification number NCT06206369. The VASCUL-AID-RETRO study aims to improve clinical practice of vascular surgery by developing artificial intelligence-driven multimodal predictive models for patients with abdominal aortic aneurysms or peripheral artery disease, enhancing personalized medicine. By integrating comprehensive data sets including clinical, imaging, and multi-omics data, these models have the potential to provide accurate risk stratification for disease progression and cardiovascular events. An innovation lies in the extensive European data set in combination with multimodal analyses approaches, which enables the development of advanced models to facilitate better understanding of disease mechanisms and progression. For clinicians, this means that more precise, individualized treatment plans can be established, ultimately aiming to improve patient outcomes.

Ongeveer 20 tot 30 % van alle cliënten met een eetstoornis herstelt niet of onvolledig. Het zijn cliënten met een ernstige en langdurige eetstoornis (severe and enduring eating disorder, SEED). Sommigen van hen hebben, ondanks dat de eetstoornis niet meer behandeld kan worden, wel verdere medisch-psychiatrische begeleiding nodig. Soms kan dat in WMO-verband, maar soms zal verdere medisch-psychiatrische begeleiding noodzakelijk zijn. Het Nederlandse zorgsysteem is op dit moment onvoldoende daarvoor ingericht. Specialistische instellingen verwijzen deze cliënten vaak naar het FACT, die echter op hun beurt specifieke kennis op eetstoornisgebied missen. Dit hoofdstuk gaat in op een vaak vergeten of genegeerde groep cliënten. De netwerkintake wordt beschreven en een flowchart opgesteld voor verwijzing na beëindiging na een reguliere eetstoornisbehandeling. In een netwerkintake worden alle probleemgebieden in kaart gebracht en de flowchart helpt de juiste medisch-psychiatrische zorgtoewijzing voor de cliënte te bepalen.

Eetstoornissen gaan vaak gepaard met talrijke somatische complicaties die het directe gevolg zijn van ondervoeding, voedingstekorten of overgewicht en obesitas. Voorbeelden zijn cardiovasculaire problemen, hart- en vaatklachten, elektrolytenafwijkingen of groeiachterstand bij jongeren. De medische component van eetstoornissen vereist directieve betrokkenheid van een arts bij de behandeling. In de meeste gevallen zal de farmacologische behandeling zich richten op de somatische aandoeningen of aanwezige psychiatrische comorbiditeit als stemmingsstoornissen, angststoornissen of slaapstoornissen. De effectiviteit van psychofarmaca voor de behandeling van de eetstoornis is beperkt.