Latest news with #TNE
Yahoo
6 days ago
- Business
- Yahoo
Technology One Limited (ASX:TNE) Shares Could Be 27% Below Their Intrinsic Value Estimate
Explore Technology One's Fair Values from the Community and select yours Key Insights Using the 2 Stage Free Cash Flow to Equity, Technology One fair value estimate is AU$52.71 Current share price of AU$38.31 suggests Technology One is potentially 27% undervalued Analyst price target for TNE is AU$36.92 which is 30% below our fair value estimate How far off is Technology One Limited (ASX:TNE) from its intrinsic value? Using the most recent financial data, we'll take a look at whether the stock is fairly priced by taking the expected future cash flows and discounting them to today's value. One way to achieve this is by employing the Discounted Cash Flow (DCF) model. Believe it or not, it's not too difficult to follow, as you'll see from our example! We generally believe that a company's value is the present value of all of the cash it will generate in the future. However, a DCF is just one valuation metric among many, and it is not without flaws. For those who are keen learners of equity analysis, the Simply Wall St analysis model here may be something of interest to you. We've found 21 US stocks that are forecast to pay a dividend yield of over 6% next year. See the full list for free. The Method We use what is known as a 2-stage model, which simply means we have two different periods of growth rates for the company's cash flows. Generally the first stage is higher growth, and the second stage is a lower growth phase. To begin with, we have to get estimates of the next ten years of cash flows. Where possible we use analyst estimates, but when these aren't available we extrapolate the previous free cash flow (FCF) from the last estimate or reported value. We assume companies with shrinking free cash flow will slow their rate of shrinkage, and that companies with growing free cash flow will see their growth rate slow, over this period. We do this to reflect that growth tends to slow more in the early years than it does in later years. Generally we assume that a dollar today is more valuable than a dollar in the future, so we discount the value of these future cash flows to their estimated value in today's dollars: 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 Levered FCF (A$, Millions) AU$166.7m AU$201.9m AU$433.3m AU$588.5m AU$741.6m AU$883.6m AU$1.01b AU$1.12b AU$1.22b AU$1.30b Growth Rate Estimate Source Analyst x7 Analyst x7 Analyst x1 Est @ 35.82% Est @ 26.01% Est @ 19.14% Est @ 14.33% Est @ 10.96% Est @ 8.61% Est @ 6.96% Present Value (A$, Millions) Discounted @ 8.0% AU$154 AU$173 AU$344 AU$432 AU$504 AU$556 AU$589 AU$605 AU$608 AU$603 ("Est" = FCF growth rate estimated by Simply Wall St)Present Value of 10-year Cash Flow (PVCF) = AU$4.6b After calculating the present value of future cash flows in the initial 10-year period, we need to calculate the Terminal Value, which accounts for all future cash flows beyond the first stage. The Gordon Growth formula is used to calculate Terminal Value at a future annual growth rate equal to the 5-year average of the 10-year government bond yield of 3.1%. We discount the terminal cash flows to today's value at a cost of equity of 8.0%. Terminal Value (TV)= FCF2035 × (1 + g) ÷ (r – g) = AU$1.3b× (1 + 3.1%) ÷ (8.0%– 3.1%) = AU$27b Present Value of Terminal Value (PVTV)= TV / (1 + r)10= AU$27b÷ ( 1 + 8.0%)10= AU$13b The total value is the sum of cash flows for the next ten years plus the discounted terminal value, which results in the Total Equity Value, which in this case is AU$17b. In the final step we divide the equity value by the number of shares outstanding. Relative to the current share price of AU$38.3, the company appears a touch undervalued at a 27% discount to where the stock price trades currently. Valuations are imprecise instruments though, rather like a telescope - move a few degrees and end up in a different galaxy. Do keep this in mind. Important Assumptions Now the most important inputs to a discounted cash flow are the discount rate, and of course, the actual cash flows. If you don't agree with these result, have a go at the calculation yourself and play with the assumptions. The DCF also does not consider the possible cyclicality of an industry, or a company's future capital requirements, so it does not give a full picture of a company's potential performance. Given that we are looking at Technology One as potential shareholders, the cost of equity is used as the discount rate, rather than the cost of capital (or weighted average cost of capital, WACC) which accounts for debt. In this calculation we've used 8.0%, which is based on a levered beta of 1.164. Beta is a measure of a stock's volatility, compared to the market as a whole. We get our beta from the industry average beta of globally comparable companies, with an imposed limit between 0.8 and 2.0, which is a reasonable range for a stable business. See our latest analysis for Technology One SWOT Analysis for Technology One Strength Earnings growth over the past year exceeded the industry. Currently debt free. Weakness Dividend is low compared to the top 25% of dividend payers in the Software market. Opportunity Annual earnings are forecast to grow faster than the Australian market. Trading below our estimate of fair value by more than 20%. Threat Revenue is forecast to grow slower than 20% per year. Next Steps: Although the valuation of a company is important, it is only one of many factors that you need to assess for a company. The DCF model is not a perfect stock valuation tool. Preferably you'd apply different cases and assumptions and see how they would impact the company's valuation. If a company grows at a different rate, or if its cost of equity or risk free rate changes sharply, the output can look very different. Can we work out why the company is trading at a discount to intrinsic value? For Technology One, there are three essential elements you should further examine: Financial Health: Does TNE have a healthy balance sheet? Take a look at our free balance sheet analysis with six simple checks on key factors like leverage and risk. Future Earnings: How does TNE's growth rate compare to its peers and the wider market? Dig deeper into the analyst consensus number for the upcoming years by interacting with our free analyst growth expectation chart. Other Solid Businesses: Low debt, high returns on equity and good past performance are fundamental to a strong business. Why not explore our interactive list of stocks with solid business fundamentals to see if there are other companies you may not have considered! PS. The Simply Wall St app conducts a discounted cash flow valuation for every stock on the ASX every day. If you want to find the calculation for other stocks just search here. Have feedback on this article? Concerned about the content? Get in touch with us directly. Alternatively, email editorial-team (at) article by Simply Wall St is general in nature. We provide commentary based on historical data and analyst forecasts only using an unbiased methodology and our articles are not intended to be financial advice. It does not constitute a recommendation to buy or sell any stock, and does not take account of your objectives, or your financial situation. We aim to bring you long-term focused analysis driven by fundamental data. Note that our analysis may not factor in the latest price-sensitive company announcements or qualitative material. Simply Wall St has no position in any stocks mentioned. Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Yahoo
28-07-2025
- Business
- Yahoo
Technology One (ASX:TNE) Might Be Having Difficulty Using Its Capital Effectively
To find a multi-bagger stock, what are the underlying trends we should look for in a business? One common approach is to try and find a company with returns on capital employed (ROCE) that are increasing, in conjunction with a growing amount of capital employed. Put simply, these types of businesses are compounding machines, meaning they are continually reinvesting their earnings at ever-higher rates of return. Having said that, while the ROCE is currently high for Technology One (ASX:TNE), we aren't jumping out of our chairs because returns are decreasing. This technology could replace computers: discover the 20 stocks are working to make quantum computing a reality. Understanding Return On Capital Employed (ROCE) If you haven't worked with ROCE before, it measures the 'return' (pre-tax profit) a company generates from capital employed in its business. To calculate this metric for Technology One, this is the formula: Return on Capital Employed = Earnings Before Interest and Tax (EBIT) ÷ (Total Assets - Current Liabilities) 0.35 = AU$166m ÷ (AU$744m - AU$273m) (Based on the trailing twelve months to March 2025). Therefore, Technology One has an ROCE of 35%. That's a fantastic return and not only that, it outpaces the average of 14% earned by companies in a similar industry. See our latest analysis for Technology One In the above chart we have measured Technology One's prior ROCE against its prior performance, but the future is arguably more important. If you'd like to see what analysts are forecasting going forward, you should check out our free analyst report for Technology One . What Can We Tell From Technology One's ROCE Trend? When we looked at the ROCE trend at Technology One, we didn't gain much confidence. To be more specific, while the ROCE is still high, it's fallen from 58% where it was five years ago. Although, given both revenue and the amount of assets employed in the business have increased, it could suggest the company is investing in growth, and the extra capital has led to a short-term reduction in ROCE. If these investments prove successful, this can bode very well for long term stock performance. On a side note, Technology One has done well to pay down its current liabilities to 37% of total assets. That could partly explain why the ROCE has dropped. Effectively this means their suppliers or short-term creditors are funding less of the business, which reduces some elements of risk. Some would claim this reduces the business' efficiency at generating ROCE since it is now funding more of the operations with its own money. What We Can Learn From Technology One's ROCE While returns have fallen for Technology One in recent times, we're encouraged to see that sales are growing and that the business is reinvesting in its operations. And the stock has done incredibly well with a 394% return over the last five years, so long term investors are no doubt ecstatic with that result. So while the underlying trends could already be accounted for by investors, we still think this stock is worth looking into further. If you're still interested in Technology One it's worth checking out our to see if it's trading at an attractive price in other respects. Technology One is not the only stock earning high returns. If you'd like to see more, check out our free list of companies earning high returns on equity with solid fundamentals. Have feedback on this article? Concerned about the content? Get in touch with us directly. Alternatively, email editorial-team (at) article by Simply Wall St is general in nature. We provide commentary based on historical data and analyst forecasts only using an unbiased methodology and our articles are not intended to be financial advice. It does not constitute a recommendation to buy or sell any stock, and does not take account of your objectives, or your financial situation. We aim to bring you long-term focused analysis driven by fundamental data. Note that our analysis may not factor in the latest price-sensitive company announcements or qualitative material. Simply Wall St has no position in any stocks mentioned. Sign in to access your portfolio
News.com.au
28-05-2025
- Business
- News.com.au
Government contracts are golden, and these ASX tech stocks are raking it in
TechnologyOne becomes Canberra's digital backbone 'Buy Australian Plan' aims to make it easier to land a public sector contract ASX tech stocks with signed government deals The third largest technology stock on the ASX, Technology One (ASX:TNE), is becoming the go-to IT backbone for governments across Australia. In its half-year deck released to the market last week, TNE reported that more than half (53%) of its revenue came from governments. With more than 230 departments and agencies already on board, the company has indeed stitched itself deep into the public sector. Recent wins include a major contract with the Australian Energy Regulator, and a $5.6 million deal with the ACT government to overhaul its development application system. So why do governments keep signing up? Well, because TechOne offers a no-fuss, fixed-fee SaaS+ model that delivers software, upgrades and support in one clean annual bill. No cost blowouts, no army of consultants, just results. Headquartered in Brisbane, TNE builds enterprise software that helps governments, councils and universities run their finances, payroll, HR, and procurement. Think of the company as the digital plumbing that keeps public services humming. In its presentation deck, TNE also said it was planning to double in size every five years. Buy Australian Plan For tech companies – especially the smaller caps – a government contract is a bit like landing a Fortune 500 client, only with steadier legs. It might not always be fast or flashy, but the revenue tends to stick around, and payment's generally reliable. A government contract could provide a stable, long-term, and recurring income for a tech company. Sure, it might take a while to get through the red tape, but once you're in, you've got a customer who doesn't ghost you when markets wobble (well, not usually anyway). Now the Australian government wants to make those contracts more accessible. Under the new 'Buy Australian Plan', Canberra is putting its money where its mouth is, using its huge buying power to back local operators, not offshore giants. The plan is all about making it easier for small businesses, First Nations companies and regional outfits to land government work without getting buried in red tape. That means clearer rules, simpler tenders, faster payments and shutting the door on tax dodgers. There's also a new Procurement Capability Branch under the plan, which will help Aussie businesses go toe-to-toe for contracts. Tech/biotechs with government deals Several ASX-listed tech and biotech names have either locked in government contracts or are being officially linked to key programs. Here are some notable examples: Macquarie Technology Group (ASX:MAQ) MAQ is one company the Aussie government seriously trusts. Around 42% of federal government agencies reportedly use MAQ's services through its Macquarie Government division. The company's Australian data centres are all Certified Strategic, meaning they're cleared to handle top-secret workloads and built to meet the toughest security standards in the country. DroneShield (ASX:DRO) DroneShield has been securing notable contracts with the Australian Defence Force (ADF) and other government agencies. In 2023, the company was awarded a $10 million Electronic Warfare contract by the Australian government, following the successful completion of a prior $3.8 million contract. Additionally, DroneShield received a $9.9 million two-year research and development contract from a Department of Defence within the Five Eyes alliance. In 2025, the company scored a $32.2 million deal via a local reseller tied to a global defence giant, with all gear heading to a major Asia-Pacific military force. Harvest Technology Group (ASX:HTG) Back in mid-2023, Harvest landed its first defence contract with a Five Eyes customer for its Nodestream technology. Nodestream helps stream high-quality video and data even in super low-bandwidth or remote environments. This tech could be used for critical defence applications involving surveillance and remote communications. It was a big step for HTG, marking the start of a potentially long-term relationship. Fast forward to early 2024, and HTG announced a follow-up – not just one, but two more orders from the same customer. The company also had other wins, including orders from the European Union Defence Force and new UK-based offshore contractors, plus a successful drone trial with Japan's Self-Defence Force. WhiteHawk (ASX:WHK) In early 2025, WhiteHawk was selected as the exclusive cyber risk partner on the US General Services Administration's SCRIPTS program. This is a 10-year, US$920 million contract vehicle focused on supply chain risk management across federal agencies. Teaming up with Knexus Research, Babel Street, and Dun & Bradstreet, WhiteHawk will provide AI-driven cyber analytics to help US agencies detect and mitigate supply chain vulnerabilities. In Australia, WhiteHawk is gradually expanding its footprint. In July 2024, the company secured a cybersecurity contract with Tabcorp. Micro-X (ASX:MX1) In February, Micro-X scored a $6 million contract extension from the US Department of Homeland Security (DHS) to keep building its self-screening airport checkpoints. It's part of a bigger deal worth up to US$14 million, and this next stage funds two more units and a full round of testing over the next 16 months. If things go well, DHS could tip in another $7.5 million to take the system all the way to live airport trials with real passengers. Micro-X was also awarded up to US$16.4 million by the US Advanced Research Projects Agency for Health (ARPA-H) to develop a world-first portable full-body CT scanner. The project leverages Micro-X's proprietary Nano Electronic X-ray (NEX) technology to create a lightweight CT scanner, approximately 225 kilograms, significantly lighter than conventional models exceeding 2000 kilograms. HiTech Group Australia (ASX:HIT) HiTech isn't your average recruiter, the company's been in the game over 30 years, quietly supplying top-shelf IT talent to more than 43 federal government departments across Australia. From Defence to Home Affairs, HIT is trusted to scout for and deliver security-cleared tech brains. As a DISP-accredited outfit, the company has practically got the keys to Canberra's back office, helping plug skill gaps in everything from IT and finance to project support. Audeara (ASX:AUA) While not holding direct government contracts per se, Audeara's headphones are officially approved as assistive listening devices under the NDIS (National Disability Insurance Scheme), DVA (Department of Veterans' Affairs), and the Hearing Services Program. This means the Australian government might help cover the cost if your hearing needs a boost. NDIS participants can claim them as low-cost assistive tech, DVA veterans can get them through the rehab appliance scheme, and under HSP, they're listed as fully subsidised alternatives. At Stockhead we tell it like it is. While Audeara and Harvest Technology are Stockhead advertisers, they did not sponsor this article.
New European
27-05-2025
- Business
- New European
Letters: Resounding silence greets Starmer's reset
Why not put a referendum on joining the European Economic Area (and therefore the single market) as a pledge for the next manifesto? Joanna Roland Re: 'A new start… and the same old lies' by Jonty Bloom (TNE #436). I hope Keir Starmer is encouraged by the right's response to his Brexit reset agreements with the EU. Lacklustre from Kemi Badenoch, absurd from Boris Johnson and Mark Francois – and Nigel Farage took himself off on holiday rather than get involved. Jonty Bloom is right – this is a pragmatic attempt to restore trade relations with our nearest and most important trading partners after a near decade of damaging disruption from a hard Brexit that the OBR (Office for Budget Responsibility) calculates has cost the UK £32bn a year. In that context, the forecast boost to the economy of £9bn by 2040 looks modest, but this deal and the UK's commitment to dynamic alignment hopefully sets us on the right course to single market status, or even re-integration itself, when the political climate allows. Paul Dolan Northwich, Cheshire It is always an immense pleasure to watch Brexiteers melt down on X and GB News whenever the letters E and U are mentioned together. Maybe one day they will understand the value of compromise and win/win, and that this is not the definition of betrayal. Guy Masters The reset deal is welcome. As for Brexit itself, as my grandad used to say: no matter how much polish, time and elbow grease you put in, the simple fact is you can't polish a turd! Christopher Harrison One important aspect missed by Ros Taylor in her fascinating article on Brexit and fishing ('Bone of contention', TNE #436) is the lack of government action over decades to help coastal communities transition away from fishing, in much the same way as former industrial areas have been left to fend for themselves in the post-industrial economy. Margaret Thatcher, of course, was the culprit-in-chief with her conviction that the state must not interfere with the free market. The real culprit is decades of underinvestment. If Lowestoft and Grimsby had been helped to diversify into other industries and were now thriving towns, I doubt fishing rights would be much of an issue. Mark Grahame Biden's advisers failed In his review of Jake Tapper and Alex Thompson's book about Joe Biden's disastrous second bid for the US presidency (TNE #436), Matthew d'Ancona rightly amplifies the argument that covering up Biden's cognitive decline was an egregious error with terrible consequences. However, the responsibility for this error lies entirely with Biden's circle of advisers, not with the man himself. While it may be tempting to blame Biden's ego, this rests on a misunderstanding of dementia. It doesn't just make people forgetful or confused about immediate circumstances. It affects all aspects of personality and judgment. It's typical for dementia sufferers to be unable to grasp what's happening to them. This is an uncomfortable and scary situation at the best of times – but when the sufferer is the leader of the free world, the risks are obviously much broader in scope than those affecting the average pensioner. Biden's advisers found themselves in an unenviable position – but they had an overwhelming responsibility, for everyone's sake, to find ways to address what was happening honestly at a much earlier stage than they did. Eleanor Toye Scott Cambridge Biden was on the side of the angels for several very good reasons. He genuinely cared about 'ordinary' people, he beat the crap out of Trump in 2020, and he and Nancy Pelosi and Chuck Schumer got some seriously good legislation through Congress despite wafer-thin majorities in the House and Senate. He (or his administration) also got the US out of Covid in good order and left the odious Trump administration an economy in very good order. The only thing I would hold against him was his inability to rein in Benjamin Netanyahu in Gaza. Biden firing on one brain cell would be better for the US and the world than Trump and his Project 2025 freakshow. David Webb Conforming to type I most certainly would not bet against David Roberts's prediction of a Conservative-Reform merger (Letters, TNE #436). Mulling it over, I also predict a name change, to Conform Party, and a Tory continuation rump party until a really embarrassing by-election loss finishes them: think the SDP's loss to the Monster Raving Loony Party, Bootle 1990. Then, with far right parties across Europe in the ascendant and teetering on the brink of EU control, it will be none other than Nigel Farage who promises a glorious future if we rejoin the EU and consequently, he secures a general election win in 2034. Finally, we then have to endure years of a hard left party agitating to take us back out. Plus ça change, plus c'est la même chose! Robert Boston Kingshill, Kent The Tories have been a major force in British politics since about 1690 (the exact date is disputed). They won elections by adjusting their sails to take advantage of any wind changes. Some called this cynical. Others called it realistic. I would never have expected the Tories to wreck themselves over an idiotic point of principle (Brexit). Is this what David Cameron meant when he described the Tory Party membership as 'swivel-eyed loons'? Don Adamson Bradford, West Yorkshire Fuel for thought Good to see a reversal of the winter fuel allowance cut in the offing (Alastair Campbell's Diary, TNE #436). It was always a mad policy, as it attracted deep criticism while raising very little. The big problem, though, is that wherever you draw the new line, how on earth do you identify the individuals who qualify? Currently it's easy but if, say, you put the line at £25,000, how do you implement payment to individuals whose income is below that line? I don't think HMRC can help. Pensioners at that level of income hardly ever complete tax returns. Tony Slater Bristol Far from unloved It was good to see two pieces in TNE #436 by Marie Le Conte – except both of them were about different ways she had been made to feel unloved and unwanted. Please be reassured that your readers, here and elsewhere, still love you! Keep up the good work. Tony Jones I felt shame and despair reading Marie Le Conte's Dilettante column in TNE #436. Keir Starmer's 'island of strangers' comment makes no sense. Most of us live in cities surrounded by strangers. Worse are his quotes 'Britain had become a one-nation experiment in open borders' and 'the damage this has done is incalculable'. Are these really the words of a leader of the Labour Party? The first statement is questionable in every word. The second seems not to be backed up by the available statistics. Why not attempt to calculate the incalculable and set out the facts plainly so we can decide ourselves? I still hope good sense will prevail. Thank you for continuing to publish your interesting and thought-provoking paper. Rosemary Brown Marie Le Conte's characterisation of the dismal no-man's-land in which she finds herself rings depressingly true. But can I assure her that the mindset and values that she espouses aren't confined to those in the age range, income brackets and locations she describes. We are everywhere: old and young, better and worse off, rural and urban. What really prevents us from making common cause is the antediluvian voting system for UK elections. That is what drives so much of the political positioning that she rightly decries. A system that seriously tried to give equal weight to everyone's preferences would be a massive step towards a truly enfranchised population and more grown-up politics. Above all, it would offer new hope – at virtually no cost. John Thomson Castle Douglas, Dumfries and Galloway Marie Le Conte is most definitely welcome in Britain. If a person of such charm, wit, and compassion isn't welcome here, then I'm off too. RSP Zatzen To counteract the threat of Reform (Letters, TNE #435), Keir Starmer should enact proportional representation to replace our first-past-the-post voting system, which in Europe we share only with the dictatorship in Belarus. This would almost certainly result in a coalition, but it would allow progressive parties to form a coherent bloc able to address the concerns of the electorate and the undemocratic voices coming from the far right. Changing the political landscape for ever would definitely be a case of thinking outside the box – clearly necessary when the whole shape of the box has so recently changed. To Starmer I would say: 'Feel the fear and do it anyway.' Robert Smith Totnes, Devon Freedom to die Sonia Sodha is in the wrong in opposing assisted dying (TNE #435). Such a decision should be entirely the prerogative of an individual without interference from anyone else. When my father was admitted to hospital in his final weeks, he knew his illness would end in delirium and hallucinations, and repeatedly expressed the wish to be 'given a pill' so that he could end his life in dignity on his terms while he was still compos mentis. A friend in Germany recently ended her life, as the German constitution allows, in the presence of a doctor and having had the necessary psychiatric/medical approval. If I ever fall ill or become disabled to the extent I can no longer enjoy life, I want the legal right to end it in a way of my choosing. No one should have the right to make me prolong my life against my wishes. No one who does not want to use a process of assisted dying need do so, but they should never impose their wishes on me. Bill Cooper Kinross, Scotland Language exchange Peter Trudgill's article on the variety of languages in the USA (TNE 434) reminded me of the London journalist William Howard Russell's trip there in 1863. In 'My Diary: North and South', Russell recorded this exchange outside Washington on the late arrival of his horse: ''Good heavens! Did I not tell you to be here at seven o'clock?' 'No, sir; Carl told me you wanted me at ten o'clock, and here I am.' 'Carl, did I not tell you to ask James to be round here at seven o'clock.' 'Not zeven clock, sere, but zehn clock. I tell him, you come at zehn clock.' 'Thus at one blow was I stricken down by Gaul and Teuton, each of whom retired with the air of a man who had baffled an intended indignity, and had achieved a triumph over a wrong-doer.' Phil Jones Bourne End, Bucks BELOW THE LINE Comments, conversation and correspondence from our online subscribers Thanks for 'The power of the underdog', Simon Barnes's wonderful tour of random underdogishness (TNE #436). 'Part of football's universal popularity is the way it provides more underdog victories than any other sport in the calendar' gives me a tiny inkling of a reason for our incomprehensible national obsession with football. John Valentine Philip Ball (Critical Mass, TNE #436) asks why MAGA is anti-science. Donald Trump is anti-science because it remains true whether you believe it or not. Science is the search for truth – anathema to Trump and MAGA. Russell Sage Re: 'A nuclear leap into the unknown' by Paul Mason (TNE #436). From the end of WWII we have had a clear idea about what was what and who was who. We were able to handle shocks like Sputnik, the death of Stalin and various White House changes, but we are no longer in that world. We now have technology we don't fully understand, coupled with an apparent collapse in old political structures. With hindsight, at the collapse of the Soviet Union we should have been looking for unforeseen consequences rather than business opportunities. Learn from this and accept we need to be nimble and cooperative, and beware of carpetbaggers like Trump. John Simpson Unfortunately, it seems the more 'intelligent' technology gets the more idiotic humanity becomes, or perhaps it's just that human intelligence is simply going to remain static while machines outpace us. The development of 'assets' such as these – ditto, hypersonic missiles and God knows what other 'toys' the military technologists are dreaming up – will, no doubt, be of enormous benefit to mankind. Steve Buch Great Lives (TNE #436) missed Robert Capa's coverage of the Battle of Troina, part of the forgotten war in Sicily, where he took poignant pictures of the encounter between the defeated Germans (with the Italians) and the ultimately victorious Americans. The inspired mayor, Fabio Venezia, has devoted a whole museum to Capa and his coverage of this largely unknown encounter. The museum is well worth a visit. Simon Stoddart JOIN THE CONVERSATION Subscribe and download our free new app to comment and chat with our writers
Medscape
14-05-2025
- Health
- Medscape
Train Advanced Practice Providers in Transnasal Endoscopy?
Advanced practice providers (APPs) can be trained to perform transnasal endoscopy (TNE) with a single-use ultra-slim gastroscope with only topical anesthesia, a pilot study showed. 'Our study showed that TNE can be performed safely by APPs, is well tolerated by patients, and significantly impacted patient management,' Whitney Kucher, PA-C, with Northwestern Medicine, Chicago, told Medscape Medical News . 'The chief benefit of having APPs perform TNEs is increasing patient access and expediting management of upper GI [gastrointestinal] symptoms in patients,' said Kucher who presented the study at Digestive Disease Week (DDW) 2025. The EvoEndo single-use endoscopy system received 510(k) clearance from the US Food and Drug Administration in early 2022. The system includes a sterile, single-use, flexible gastroscope designed for unsedated transnasal upper endoscopy and a small portable video controller. Unsedated TNE can be used to evaluate and diagnose a wide range of upper GI conditions that may require frequent monitoring, including eosinophilic esophagitis (EoE), dysphagia, celiac disease, gastroesophageal reflux disease (GERD), Barrett's esophagus (BE), malabsorption, and abdominal pain. Kucher and colleagues assessed the ability for APPs to use the EvoEndo system to perform safe and accurate esophageal assessment using in-office TNE, following training. TNE training lasted about 4 weeks and consisted of a stepwise approach involving lectures, simulation-based training, and hands-on supervised TNEs (10 per APP). Once training was completed, and after providing consent, 25 patients were enrolled to undergo supervised TNE by an APP. Their mean age was 55 years, and 58% were women. Indications for TNE were uncontrolled GERD symptoms in 12 patients, history of EoE in six patients, high-risk screening for BE in five patients, and dysphagia in two patients. Technical success was achieved in all but one patient (96%), and there were no adverse events. All 25 patients completed the procedure, with 17 (72%) giving it a TNEase score of 1 (with ease/no discomfort) or 2 (mild/occasional discomfort). Only two patients reported a score of 4 (very uncomfortable) but still completed the exam. The average TNE procedure time was 7.3 minutes. TNE findings changed management in 23 of 25 (92%) patients. The test led to a change in proton pump inhibitor dosing or interval in 14 patients (56%). Esophagogastroduodenoscopy (EGD) interval was extended in five patients (20%) and scheduled sooner in three patients (12%). Two patients (8%) had no change in management. The study team said more data are needed in terms of learning curves, competency metrics, and health economics before widespread adoption can be supported. 'We are working on developing a standardized training plan so we can train more GI APPs in our department. We have plans to start an APP-driven TNE program in the coming months,' Kucher told Medscape Medical News . Caveats and Cautionary Notes Commenting on this study for Medscape Medical News , Amitabh Chak, MD, president of the American Society for Gastrointestinal Endoscopy, noted that the results are 'similar to older studies where TNE appeared quite promising and APPs could be trained. There have been previous studies that APPs can perform colonoscopies and EGDs.' Chak cautioned that previous studies showed that it took at least 50 supervised examinations for APPs to achieve the needed skills. 'Intubation transnasally can be painful for patients if not done with skill. Cognitive skills take longer. The gastroesophageal junction is dynamic, and recognition of subtle pathology takes training,' Chak noted. 'TNE has been around at least two decades. The challenge with uptake of TNE for Barrett's screening has been acceptance by primary care physicians, patients and payers,' Chak told Medscape Medical News .
