ORCID Profile
0000-0002-6803-2071
Current Organisation
Liverpool Hospital
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Publisher: Wiley
Date: 15-05-2018
DOI: 10.1111/JHN.12561
Abstract: The ability to achieve optimal glycaemic control varies widely among in iduals with type 1 diabetes. The present study aimed to explore the factors that are associated with optimal glycaemic control compared to suboptimal control. An observational study design was used to explore the association of various factors with glycaemic control. Surveys were completed by in iduals who attended the type 1 diabetes clinic at a tertiary hospital in New South Wales (NSW), Australia. Clinical and demographic information and attendance at dietary review were also collected. One hundred and three in iduals completed the survey. Those with optimal control [glycated haemoglobin ≤7.0% (53 mmol mol The present study identified that consistency in taking insulin and confidence in self-management was associated with better glycaemic control. An association was also found between recent dietary review and better carbohydrate knowledge, although this did not translate into better glycaemic control. Future investigation into the application of carbohydrate knowledge is required.
Publisher: Wiley
Date: 25-04-2022
DOI: 10.1111/JEP.13688
Abstract: Details of the development and implementation of integrated care pathways (ICPs) in the context of electronic collection of patient reported outcomes (ePROs) for cancer patients are largely lacking in the literature. This study describes what, why and how decisions were made to adapt and implement an ePROs ICP for patients with lung cancer. A consensus process was utilized, with the implementation advisory group including multidisciplinary representation from three participating hospitals, to identify local ch ions and adapt and incorporate the ePRO ICP into the local contexts. Engagement meetings were documented via meeting transcripts, and detailed notes from October 2019 to November 2020 were content‐analysed to identify decision‐making themes based on the Consolidated Framework for Implementation Research workflows and process maps were reviewed and modified to integrate ePROs. In total, 55 engagement activities were held (24 meetings, 20 workshops 11 educational sessions), with n = 96 staff from multiple disciplines participating in the ePROs implementation through advisory meetings, process mapping, change management and staff education. Decisions were made regarding eligible patient cohorts to include, the process for onboarding patients onto the ePRO system, and follow‐up and referral pathways. Rationales for decisions included alignment with existing workflows, utilizing available staff, minimizing staff and patient burden and maximizing patient engagement. Existing resources, staff input and technical and logistical reasons often guided the ICP decisions, highlighting the need for in‐depth engagement across all stakeholders for optimal implementation of ePRO ICPs. The ePRO implementation required substantial dialogue and systematic resolution to reach agreement on the final processes. Adapting the local ICP through rigorous engagement facilitated the successful implementation of ePROs as business‐as‐usual at all three cancer centres. Involving all relevant stakeholders is critical to the successful adaptation of ICPs before their introduction into routine care.
Publisher: Wiley
Date: 04-09-2020
Abstract: Communication is the main method used by dietitians to conduct their practice. Yet, few evidence‐based tools are available to assess dietitians' communication skills to guide skill development. Further, workplace peer review programs for assessment of communication skills are not standard practice. DIET‐COMMS is a validated tool to assess dietitians' communication skills in patient consultations. The aims of this study were to implement a workplace peer review program using the DIET‐COMMS tool, assess dietitians' communication skills, evaluate inter‐rater reliability and dietitian satisfaction. Single site study within Australian hospital dietetics department. Training for DIET‐COMMS usage was undertaken with assessors (senior dietitians) and dietitians being assessed using an online training package and face‐to‐face group sessions. The peer review process consisted of two rounds, occurring four to six months apart. The first round was undertaken with two assessors to evaluate inter‐rater reliability. An online survey was conducted to evaluate dietitian satisfaction. Seventeen dietitians completed the program. In the first round, 13 of 17 dietitians scored 76% to 100% on the DIET‐COMMS tool (median = 85%, interquartile range [IQR] = 77‐93). All dietitians scored 76‐100% (median = 98%, IQR = 94‐100) in the second round, with significantly higher scores compared to the first (98% vs 85% P ‐value .001). The intra‐class correlation coefficient was 0.86 (95% confidence interval = 0.64‐0.95), indicating good‐excellent inter‐rater reliability. All dietitians reported the tool measured the nutrition care process adequately and was applicable to practice. The peer review program using DIET‐COMMS was successfully implemented within a workplace environment. Widespread implementation of peer review programs using DIET‐COMMS is recommended as a standard practice for the profession.
Publisher: Wiley
Date: 07-06-2018
DOI: 10.1111/JHN.12569
Abstract: Communication is the primary method in which dietitians conduct their practice. However, continuing education and competency standards are often focused on clinical knowledge and skills, with few programs being available to improve the communication and nutrition counselling skills of dietitians. Dietitians have reported reduced confidence in the knowledge and use of these skills, particularly when dealing with people who are struggling to find motivation to change their eating behaviours. The present study aimed to evaluate the effect of a workplace education program on the self-reported communication and nutrition counselling skills of dietitians. An education program was developed using techniques from motivational interviewing, patient-centred therapy, solution-focused therapy and narrative therapy. These techniques were chosen based on evidence of potential application to dietetic practice for behaviour change. Dietitians working in acute care hospitals and community health services completed the program. Pre- and post-written surveys incorporating five-point Likert scales (1-5) were used to evaluate the program. The results were analysed using parametric and nonparametric statistics. Fifty dietitians completed the program and evaluation. The dietitians' self-rating of their communication and nutrition counselling skills improved significantly (median = 3 versus 4, Z = 4.562, P < 0.001, r = 0.65). Dietitians also reported knowledge of a greater variety of behaviour change techniques to use with their patients post-program. To our knowledge, this is the first dietitian-specific workplace education program of its type to address essential skills for better communication with patients. Ongoing workplace support, such as peer observation, is recommended to assist with skill development and sustainability.
Publisher: Wiley
Date: 19-09-2017
Abstract: The aims of this study were to investigate the nutritional management practice and nutritional status of patients with oesophageal and gastro-oesophageal cancers, and to propose strategies for improving their nutritional and clinical outcomes. All patients diagnosed with oesophageal and gastro-oesophageal cancers and treated with chemotherapy and/or radiotherapy at the Liverpool Cancer Therapy Centre (between August 2010 and February 2014) were included in this retrospective study. Patient and tumour characteristics, nutritional status and management were compared to clinical outcomes. A total of 69 patients met the inclusion criteria. The median weight loss prior to treatment commencement was 10.5% (Interquartile Range (IQR) = 6.6-15.4). A decline in nutritional status continued throughout the treatment course. The median percentage of weight loss during treatment was 3.53% (IQR = 0.00-6.84). Seven and 19 patients required nutrition intervention using a feeding tube or stent insertion to manage dysphagia, respectively. In patients treated with a curative intent, radiotherapy was completed in 100% of those with a nasogastric tube insertion as compared to 80% who had a stent insertion. There was a higher percentage of patients from culturally and linguistically erse (CALD) background, experiencing significant weight loss when compared with their non-CALD counterparts (P = 0.04). Patients with oesophageal and gastro-oesophageal cancers commonly present with significant weight loss and this continues during the course of their anti-cancer treatment. A standardised protocol of nutrition management for these cancer patients is recommended, focusing on assisting patients from CALD backgrounds.
Publisher: Informa UK Limited
Date: 29-11-2021
Publisher: Wiley
Date: 30-11-2022
DOI: 10.1111/JHN.12969
Abstract: Accurate dietary intake data are critical to nutrition care planning. Commonly used food record charts (FRC) are paper‐based, time consuming, require nutrient analysis estimations, and may provide limited accuracy. The present study aimed to validate Mobile Intake® (MI) (an electronic food intake tool incorporating the five‐point visual scale and providing automatic nutrient analysis) for usability and efficacy in quantifying dietary intake in the healthcare setting. Two research stages within two tertiary hospitals included: (1) examining criterion validity and efficiency of dietary intake quantification using FRC and MI compared to the gold standard weighed food record (WFR) in a controlled environment and (2) comparing efficiency and effectiveness of FRC and MI in usual care conditions. In Stage 1, dietary intake was calculated ( n = 90) with a significant difference across all methods (FRC, MI and WFR) for energy ( p = 0.04), but not between MI and WFR ( p = 1.00). The time taken for MI (40 s) was significantly less than FRC (174 s) and WFR (371 s) ( p 001). In Stage 2, dietary intake was determined ( n = 210) using FRC and MI. Sufficient data to complete dietary analysis were available for 35% of meals from FRC compared to 98% from MI. Calculated mean daily energy intake (4764 ± 1432 kJ vs. 6636 ± 2519 kJ, p = 0.002) and mean daily protein intake (62.9 ± 12.7 g vs. 78.5 ± 22.2 g, p = 0.007) were significantly lower with FRC compared to MI. Average time to complete MI was 14.4 seconds. MI demonstrates efficacy as an accurate measure of dietary intake compared to WFR, as well as usability, providing faster, more accurate and comprehensive real‐time intake data in practice than FRC.
Publisher: Australasian College of Health Service Management
Date: 14-04-2019
Abstract: Objective: This paper explores the professional identity (PI) of Allied Health Managers (AHMs) and how their identity is typically constructed. Methods: A qualitative research methodology utilising semi-structured interviews was employed for this research. Thematic analysis was used to extract relevant data from the transcripts. Settings: The study was undertaken in five acute hospitals within one of the largest metropolitan Local Health Districts in New South Wales, Australia. A total of sixteen AHMs and deputy AHMs were interviewed. Results: Three key themes identified were: PI of AHM, motivation of becoming a manager, and construction of their identity. Factors motivating AHMs to follow a management pathway were identified as being a natural progression and having interest in high-level decision-making. Despite AHMs sharing similar role conflict as the medical managers, they adapted to hybrid manager roles with minimal resentment. They also adopted to the hybrid manager role with a positive, realistic and flexible perspective. Conclusion: Despite facing role conflict as a hybrid-professional-manager, AHMs manage the transition from clinicians to managers with a positive approach. This indicates that AHMs may require certain skills or characteristics to successfully construct their PI.
Publisher: Wiley
Date: 13-08-2020
DOI: 10.1111/NEP.13639
Abstract: A multidisciplinary approach, including dietetics, is considered the optimal model of care for dialysis preparation. Dietetic consultation (DC) focuses on symptom management and dietary changes to delay time to dialysis. Evidence of the effectiveness of DC on time to dialysis is limited. This study aimed to investigate the impact of DC on time to dialysis for patients attending a pre-dialysis clinic. A retrospective cohort study was designed to include all patients attending outpatient pre-dialysis clinics at a large metropolitan renal service between January 2014 and March 2018. Time to dialysis (days) was compared between patients that received DC and those who did not. Cox proportional hazards analysis allowing for adjustment of differences and confounders was undertaken. A cohort of 246 patients was identified. Median estimated glomerular filtration rate was 16mL/min per 1.73 m DC provided to patients attending a pre-dialysis clinic was associated with a delayed time to dialysis. Standardised referral pathways to improve patient access to renal dietetic services are recommended to optimise care.
Publisher: Springer Science and Business Media LLC
Date: 22-10-2014
Abstract: Hyperglycaemia is commonly observed in patients with diabetes mellitus (DM) while receiving enteral nutrition (EN) in hospital, and hyperglycaemia has been shown to be associated with poor clinical outcomes. The aim of this study was to assess the glycaemic status of patients with DM who received EN during hospital admission and evaluate the impact of intervention by a specialist diabetes team (SDT) on glycaemic control and clinical outcomes of these patients. A retrospective review of patients with DM who required EN during hospital admission was conducted. We compared patient characteristics, glycaemic profile and clinical outcomes between patients who were managed by SDT and those who were managed by the admitting team. Seventy-four patients with DM on EN were included in this study, of whom 27 were managed by SDT while on EN. Compared with patients managed by the admitting team, those who were reviewed by SDT had better glycaemic control during the period of EN as well as during the 24 h after EN was ceased. These patients also had shorter length-of-stay in hospital and lower in-patient mortality. Our findings confirmed that there was a role for SDT in managing patients with DM who received EN during their hospital admission. These patients had improved glycaemic control while receiving EN and had better clinical outcomes. Further prospective studies will be required to validate the findings of this study.
Location: Australia
No related grants have been discovered for Ka Hi Mak.