ORCID Profile
0000-0001-6321-8558
Current Organisations
Metro North Hospital and Health Service
,
University of Queensland
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Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.APPET.2016.04.032
Abstract: Parental feeding practices and children's eating behaviours are inter-related and both have been implicated in the development of childhood obesity. However, research on the parent-child feeding relationship during the first few months of life is limited. The aim of this study was to examine the cross-sectional relationship between maternal feeding beliefs and practices and infant eating behaviours in a community s le. Mothers (N = 413) of 4 month old infants recruited during pregnancy for the New Beginnings: Healthy Mothers and Babies study self-reported feeding beliefs ractices and eating behaviours of their infants on established tools. Data on a comprehensive range of maternal and infant characteristics were also collected. Multivariable regression models were used to assess the associations between five feeding beliefs and practices and four eating behaviours, adjusting for key maternal and infant covariates. Mothers concerned about their infant becoming underweight rated the infant higher on satiety responsiveness and lower on enjoyment of food. Higher awareness of infant feeding cues was associated with higher infant enjoyment of food. Mothers concerned about their infant becoming overweight and those who used food to calm their baby rated the infant as higher on food responsiveness. Feeding to a schedule (vs on demand) was not associated with any of the infant eating behaviours. A relationship between maternal feeding beliefs and practices and infant eating behaviours is apparent early in life, therefore longitudinal investigation to establish the directions of this relationship is warranted.
Publisher: Wiley
Date: 17-03-2023
DOI: 10.1002/HPJA.715
Abstract: A lack of programs to develop clinician knowledge and confidence to address weight gain within pregnancy is a barrier to the provision of evidence‐based care. To examine the reach and effectiveness of the Healthy Pregnancy Healthy Baby online health professional training program. A prospective observational evaluation applied the reach and effectiveness elements of the RE‐AIM framework. Health professionals from a range of disciplines and locations were invited to complete questionnaires before and after program completion assessing objective knowledge and perceived confidence around aspects of supporting healthy pregnancy weight gain, and process measures. There were 7577 views across all pages over a year period, accessed by participants across 22 Queensland locations. Pre‐ and post‐ training questionnaires were completed 217 and 135 times, respectively. The proportion of participants with scores over 85% and of 100% for objective knowledge was higher post training ( P ≤ .001). Perceived confidence improved across all areas for 88%–96% of those who completed the post‐ training questionnaire. All respondents would recommend the training to others. Clinicians from a range of disciplines, experience and locations accessed and valued the training, and knowledge of, and confidence in delivering care to support healthy pregnancy weight gain improved after completion. This effective program to build the capacity of clinicians to support healthy pregnancy weight gain offers a model for online, flexible training highly valued by clinicians. Its adoption and promotion could standardise the support provided to women to encourage healthy weight gain during pregnancy.
Publisher: Wiley
Date: 02-10-2020
DOI: 10.1111/AJO.13053
Abstract: Excess gestational weight gain is associated with adverse pregnancy outcomes. Addressing barriers to the provision of best practice care that supports healthy pregnancy weight gain could assist staff in clinical care however, little is known about changes to staff practices after ameliorating barriers. To evaluate if service initiatives to promote healthy pregnancy weight gain improve weight-related documentation by antenatal staff throughout pregnancy care. Service initiatives including staff training, familiarisation with a pregnancy weight gain chart and placement of scales in clinic rooms were introduced. Pregnancy health records were audited for deliveries pre- (2014) and post-implementation (2017) to obtain weight-related measures. Measures assessed included the documentation of pre-pregnancy weight, height, pre-pregnancy body mass index (BMI), referral to dietetic services (if overweight) and the accuracy of pre-pregnancy BMI calculation. The proportion of visits with weight recorded during pregnancy was also audited. A total of 1003 and 1050 records were included from the pre- and post-intervention groups respectively. Significant improvements over time were observed in the documentation of pre-pregnancy weight (P < 0.001), BMI (P < 0.001), accuracy of BMI calculation (P < 0.001) and for obese women proportion of visits with weight recorded (P = 0.02). There was a non-significant increase in the documentation of dietetic referral for overweight women (1.1% vs 2.2%, P = 0.27) and proportion of visits with weight recorded for women across all pre-pregnancy BMI groups (49% vs 51%, P = 0.07). Addressing barriers to supporting healthy pregnancy weight gain through service-wide initiatives may improve weight-related documentation by antenatal staff.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.JAND.2016.12.011
Abstract: Excess gestational weight gain (GWG) contributes to long-term obesity in mothers and children. To guide the tailoring of interventions to prevent excess GWG, a better understanding is needed of the lifestyle-related health cognitions that influence women's attempts to manage GWG. To examine the relationship between health cognitions and excess GWG for women who enter pregnancy at a healthy weight (body mass index <25) or overweight (body mass index ≥25). It was hypothesized that health cognitions with a positive (negative) influence on health behavior would be associated with lower (higher) likelihood of excess GWG and that specific associations would differ between weight status groups. This prospective, observational study commenced when participants were <20 weeks' gestation, continuing until the end of their pregnancy. A self-administered quantitative survey at recruitment assessed prepregnancy weight and lifestyle-related health cognitions. Height was measured at 16 weeks and weight at 36 weeks using standard procedures. A consecutive s le of pregnant women (n=715) were recruited from an Australian metropolitan hospital between August 2010 and January 2011. All women <20 weeks' gestation were eligible unless they had preexisting type 1 or 2 diabetes or insufficient English language skills to complete questionnaires. Excess GWG defined according to Institute of Medicine 2009 recommendations and predisposing, reinforcing, and enabling cognitions for lifestyle health behaviors. Logistic regression analyses examined associations between health cognitions and excess GWG stratified for prepregnancy weight status. For healthy-weight women, higher weight locus of control scores were protective against excess GWG (odds ratio 0.6, 95% CI 0.4 to 0.8), whereas higher perceived risk scores (personal risk and risk arising from prepregnancy weight) (odds ratio 1.3, 95% CI 1.1 to 1.7) were associated with excess GWG. For overweight women higher negative outcome expectation scores were associated with an increased risk of excess GWG (odds ratio 1.4, 95% CI 1.1 to 2.0). Lifestyle-related health cognitions are associated with excess GWG and differed by prepregnancy weight status, suggesting the need to tailor behavior change interventions accordingly.
Publisher: Wiley
Date: 23-05-2023
DOI: 10.1111/AJO.13696
Abstract: Previously, management of gestational diabetes (GDM) has focused largely on glycaemic control, with a view to reduce the occurrence of large‐for‐gestational‐age (LGA) infants. However, tight glycaemic control in GDM is associated with a higher incidence of small‐for‐gestational‐age (SGA) infants, which has been linked to higher rates of adverse outcomes. The aim was to characterise risk factors associated with having an SGA infant in women being treated for GDM. This was a retrospective observational cohort study of 308 women with GDM. Women were split into groups based on their infant's size at delivery (SGA, appropriate‐for‐gestational‐age (AGA) or LGA). Literature review and expert opinion helped to determine several predictors of women with GDM delivering an SGA infant, and statistical analysis was used to produce odds ratios (OR) for these predictors. The s le included primiparous women with a mean pre‐pregnancy body mass index (BMI) of 25.72 (standard deviation: 5.75). Metabolic risk factors associated with delivering an SGA infant included a lower pre‐pregnancy BMI (adjusted OR 1.13, P = 0.04, 95% confidence interval (CI): 1.01–1.26), a lower fasting blood glucose level (BGL) (adjusted OR: 3.21, P = 0.01, 95% CI: 1.30–7.93) and growth that was high risk for SGA at baseline ultrasound scan (USS) (adjusted OR: 7.43, P 0.001, 95% CI: 2.93–18.79). The combined clinical picture of lower pre‐pregnancy BMI, fasting BGL and baseline USS growth measurements may indicate a need for less aggressive glucose management in women with GDM to prevent SGA infants.
Publisher: JMIR Publications Inc.
Date: 18-03-2021
DOI: 10.2196/27196
Abstract: Despite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited. This study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service. Metrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ≥16 years without pre-exiting diabetes with a prepregnancy BMI kg/m2 and gaining weight above recommendations at weeks’ gestation who are referred for dietetic care during the 12-month study period will be eligible for participation. The setting is a metropolitan hospital at which approximately 6% of the national births in Australia take place each year. Eligible participants will receive up to 10 telecoaching calls during their pregnancy. Primary outcomes will be service level indicators of reach, adoption, and implementation that will be compared with a retrospective control group, and secondary effectiveness outcomes will be participant-reported anthropometric and behavioral outcomes all outcomes will be assessed pre- and postprogram completion. Additional secondary outcomes relate to the costs associated with program implementation and pregnancy outcomes gathered through routine clinical service data. Data collection of all variables was completed in December 2020, with results expected to be published by the end of 2021. This study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care. DERR1-10.2196/27196
Publisher: AMPCo
Date: 08-03-2021
DOI: 10.5694/MJA2.50974
Publisher: Springer Science and Business Media LLC
Date: 27-11-2018
Publisher: Wiley
Date: 16-10-2023
Publisher: Springer Science and Business Media LLC
Date: 18-05-2022
DOI: 10.1186/S12884-022-04750-8
Abstract: Prevention of weight gain outside recommendations is a challenge for health services, with several barriers to best practice care identified. The aim of this pragmatic implementation study with a historical control was to examine the impact of implementing a service wide education program, and antenatal care pregnancy weight gain chart combined with brief advice on women’s knowledge of recommended gestational weight gain (GWG), the advice received and actual GWG. The PRECEDE PROCEED Model of Health Program planning guided intervention and evaluation targets and an implementation science approach facilitated service changes. Pregnant women 22 weeks’ gestation attending the antenatal clinic at a metropolitan birthing hospital in Australia were recruited pre (2010, n = 715) and post (2016, n = 478) implementation of service changes. Weight measurements and questionnaires were completed at recruitment and 36 weeks’ gestation. Questionnaires assessed advice received from health professionals related to healthy eating, physical activity, GWG, and at recruitment only, pre-pregnancy weight and knowledge of GWG recommendations. Women who correctly reported their recommended GWG increased from 34% (pre) to 53% (post) ( p 0.001). Between pre and post implementation, the advice women received from midwives on recommended GWG was significantly improved at both recruitment- and 36-weeks’ gestation. For normal weight women there was a reduction in GWG (14.2 ± 5.3 vs 13.3 ± 4.7 kg, p = 0.04) and clinically important reduction in excess GWG between pre and post implementation (31% vs 24%, p = 0.035) which remained significant after adjustment (AOR 0.53 [95%CI 0.29–0.96]) ( p = 0.005). Service wide changes to routine antenatal care that address identified barriers to supporting recommended GWG are likely to improve the care and advice women receive and prevent excess GWG for normal weight women.
Publisher: MDPI AG
Date: 13-04-2021
DOI: 10.3390/NU13041266
Abstract: Background: Maternal triglycerides are increasingly recognised as important predictors of infant growth and fat mass. The variability of triglyceride patterns during the day and their relationship to dietary intake in women in late pregnancy have not been explored. This prospective cohort study aimed to examine the utility of monitoring capillary triglycerides in women in late pregnancy. Methods: Twenty-nine women (22 with gestational diabetes (GDM) and 7 without) measured capillary glucose and triglycerides using standard meters at home for four days. On two of those days, they consumed one of two standard isocaloric breakfast meals: a high-fat/low-carbohydrate meal (66% fat) or low fat/high carbohydrate meal (10% fat). Following the standard meals, glucose and triglyceride levels were monitored. Results: Median capillary triglycerides were highly variable between women but did not differ between GDM and normoglycaemic women. There was variability in capillary triglycerides over four days of home monitoring and a difference in incremental area under the curve for capillary triglycerides and glucose between the two standard meals. The high-fat standard meal lowered the incremental area under the curve for capillary glucose (p 0.0001). Fasting (rho 0.66, p = 0.0002) and postpradial capillary triglycerides measured at home correlated with venous triglyceride levels. Conclusions: The lack of differences in response to dietary fat intake and the correlation between capillary and venous triglycerides suggest that monitoring of capillary triglycerides before and after meals in pregnancy is unlikely to be useful in the routine clinical practice management of women with gestational diabetes mellitus.
Publisher: Elsevier BV
Date: 11-2020
DOI: 10.1016/J.WOMBI.2020.01.005
Abstract: More than half of women start pregnancy above a healthy weight and two-thirds gain excess weight during pregnancy, increasing the risk of complications. Little research has examined the influence model of care has on weight-related outcomes in pregnancy. To explore how continuity vs non-continuity models of midwifery care influence perceived readiness to provide woman-centred interventions with women supporting pregnancy weight gain, healthy eating and physical activity. Focus groups were conducted with midwives working in either continuity or non-continuity models of care at a tertiary hospital in Queensland, Australia. Focus group questions elicited elements around practices, the healthcare environment and woman-centred care skills. Findings were analysed using the Framework Approach to qualitative research. Four focus groups, involving 15 participants from the continuity of care model and 53 from the non-continuity model, were conducted. Continuity of care participants reported greater readiness to provide woman-centred interventions than those from non-continuity models. Barriers faced by both groups included gaps in communication training, education resources and multidisciplinary support. Midwives across models of care require greater support in this area, in particular training in communication and better multidisciplinary service integration to support women. The care model appears to influence capacity to deliver person/woman-centred interventions, highlighting the need for tailored training for the healthcare setting. The roles of other health professionals in delivering weight management interventions during pregnancy also need to be examined.
Publisher: JMIR Publications Inc.
Date: 25-11-2022
DOI: 10.2196/37552
Abstract: Digital health resources have the potential to assist women in optimizing gestational weight gain (GWG) during pregnancy to improve maternal health outcomes. In this study, we aimed to evaluate the quality and behavior change potential of publicly available digital tools (websites and apps) that facilitate GWG tracking. Digital tools were identified using key search terms across website search engines and app stores and evaluated using the Mobile App Rating Scale, the App Behavior Change Scale, as well as criteria to evaluate the rigor and safety of GWG information. Overall, 1085 tools were screened for inclusion (162 websites and 923 apps), and 19 were deemed eligible. The mean Mobile App Rating Scale quality score was 3.31 (SD 0.53) out of 5, ranging from 2.26 to 4.39, and the mean App Behavior Change Scale score was 6 (SD 3.4) out of 21, ranging from 19 to 0. Of the 19 items used to evaluate rigor of GWG advice, most tools (n=11, 57.9%) contained ≤3 items. This review emphasizes the substantial limitations in current digital resources promoting the monitoring and optimization of GWG. Most tools were of low quality, had minimal behavior change potential, and were potentially unsafe, with minimal linkage to evidence-based information or partnership with health care.
Publisher: MDPI AG
Date: 12-04-2023
DOI: 10.3390/NU15081860
Abstract: Living Well during Pregnancy (LWdP) is a telephone-based antenatal health behavior intervention that has been shown to improve healthy eating behaviors and physical activity levels during pregnancy. However, one-third of eligible, referred women did not engage with or dropped out of the service. This study aimed to explore the experiences and perceptions of women who were referred but did not attend or complete the LWdP program to inform service improvements and adaptations required for scale and spread and improve the delivery of patient-centered antenatal care. Semi-structured telephone interviews were conducted with women who attended ≤2 LWdP appointments after referral. The interviews were thematically analyzed and mapped to the Theoretical Domains Framework and Behavior Change Wheel/COM-B Model to identify the barriers and enablers of program attendance and determine evidence-based interventions needed to improve service engagement and patient-centered antenatal care. Three key themes were identified: (1) the program content not meeting women’s expectations and goals (2) the need for flexible, multimodal healthcare and (3) information sharing throughout antenatal care not meeting women’s information needs. Interventions to improve women’s engagement with LWdP and patient-centered antenatal care were categorized as (1) adaptations to LWdP, (2) training and support for program dietitians and antenatal healthcare professionals, and (3) increased promotion of positive health behaviors during pregnancy. Women require flexible and personalized delivery of the LWdP that is aligned with their in idual goals and expectations. The use of digital technology has the potential to provide flexible, on-demand access to and engagement with the LWdP program, healthcare professionals, and reliable health information. All healthcare professionals are vital to the promotion of positive health behaviors in pregnancy, with the ongoing training and support necessary to maintain clinician confidence and knowledge of healthy eating, physical activity, and weight gain during pregnancy.
Publisher: Springer Science and Business Media LLC
Date: 07-08-2023
DOI: 10.1038/S41430-023-01318-3
Abstract: Bariatric surgery may increase the risk of micronutrient deficiencies however, confounders including preoperative deficiency, supplementation and inflammation are rarely considered. To examine the impact of bariatric surgeries, supplementation and inflammation on micronutrient deficiency. Two public hospitals, Australia. Participants were recruited to an observational study monitoring biochemical micronutrient outcomes, supplementation dose, inflammation and glycaemic control, pre-operatively and at 1–3, 6 and 12 months after gastric bypass (GB Roux-en-Y Gastric Bypass and Single Anastomosis Gastric Bypass N = 66) or sleeve gastrectomy (SG N = 144). Participant retention at 12 months was 81%. Pre-operative micronutrient deficiency was common, for vitamin D (29–30%), iron (13–22%) and selenium (39% GB cohort). Supplement intake increased after surgery however, dose was % of target for most nutrients. After SG, folate was vulnerable to deficiency at 6 months (OR 13 [95% CI 2, 84] p = 0.007), with folic acid supplementation being independently associated with reduced risk. Within 1–3 months of GB, three nutrients had higher deficiency rates compared to pre-operative levels vitamin B1 (21% vs. 6%, p 0.01), vitamin A (21% vs. 3%, p 0.01) and selenium (59% vs. 39%, p 0.05). Vitamin B1 deficiency was independently associated with surgery and inflammation, selenium deficiency with improved glycaemic control after surgery and inflammation, whilst vitamin A deficiency was associated with inflammation only. In the setting of prophylactic post-surgical micronutrient prescription, few nutrients are at risk of de novo deficiency. Although micronutrient supplementation and monitoring remains important, rationalising high-frequency biochemical testing protocols in the first year after surgery may be warranted.
Publisher: Wiley
Date: 14-02-2023
DOI: 10.1111/JMWH.13477
Abstract: Current antenatal guidelines advocate for regular weighing of women during their pregnancy, with supportive conversations to assist healthy gestational weight gain (GWG). To facilitate overcoming weight monitoring barriers, a pregnancy weight gain chart (PWGC), coupled with brief intervention advice, was implemented in 2016 to guide provider and woman‐led routine weight monitoring. This study aimed to examine the extent to which the use of PWGCs and routine advice provision were normalized into routine antenatal care following enhanced implementation strategies and whether this led to a change in GWG. This pre‐post study included data from 2010 (preimplementation), 2016, and 2019 (postimplementation). A retrospective audit of health records and PWGCs was undertaken to assess adherence to chart use and evaluate GWG outcomes. A survey was sent to women in 2010 and repeated in 2019 to understand the advice women received from health care professionals. Compared with the preimplementation cohort (2010), more women achieved a healthy GWG in 2019 (42% vs 31%, P = .04). In 2019, having 3 or more weights recorded was associated with a reduction in excess GWG ( P = .028). More women reported receiving helpful advice about healthy GWG in 2019 compared with 2010, although minimal changes to advice received about nutrition and physical activity were observed. Enhanced implementation strategies and ongoing efforts to optimize supportive antenatal care practices are required to effect positive change in GWG. Further evaluation of the perspectives of pregnant women and counseling practices of health professionals is needed.
Publisher: Springer Science and Business Media LLC
Date: 22-07-2016
DOI: 10.1007/S10995-016-2148-0
Abstract: Objectives Little is known about the antecedents to dietary and physical activity behaviours that can support healthy gestational weight gain (GWG) across different weight status groups in pregnancy. The aim of this study was to use constructs common to dominant health behaviour theories to determine if predisposing, reinforcing and enabling factors for healthy eating, physical activity and weight gain differed between healthy and overweight pregnant women. Methods Pregnant women (n = 664) aged 29 ± 5 (mean ± SD) years were recruited at 16 ± 2 weeks gestation. Measures were self-reported pre-pregnancy weight, psychosocial constructs for healthy eating, physical activity and GWG and demographic data. Height was measured at 16 weeks. Psychosocial constructs were compared between women with pre-pregnancy weight status of healthy (BMI < 25 kg/m
Publisher: JMIR Publications Inc.
Date: 17-01-2021
Abstract: espite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited. his study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service. etrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ≥16 years without pre-exiting diabetes with a prepregnancy BMI & kg/m sup /sup and gaining weight above recommendations at & weeks’ gestation who are referred for dietetic care during the 12-month study period will be eligible for participation. The setting is a metropolitan hospital at which approximately 6% of the national births in Australia take place each year. Eligible participants will receive up to 10 telecoaching calls during their pregnancy. Primary outcomes will be service level indicators of reach, adoption, and implementation that will be compared with a retrospective control group, and secondary effectiveness outcomes will be participant-reported anthropometric and behavioral outcomes all outcomes will be assessed pre- and postprogram completion. Additional secondary outcomes relate to the costs associated with program implementation and pregnancy outcomes gathered through routine clinical service data. ata collection of all variables was completed in December 2020, with results expected to be published by the end of 2021. his study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care. ERR1-10.2196/27196
Publisher: Springer Science and Business Media LLC
Date: 12-08-2020
Publisher: Springer Science and Business Media LLC
Date: 04-06-2015
DOI: 10.1038/JP.2015.57
Abstract: The objective of this study was to evaluate weight-related risk perception in early pregnancy and to compare this perception between women commencing pregnancy healthy weight and overweight. Pregnant women (n=664) aged 29±5 (mean±s.d.) years were recruited from a metropolitan teaching hospital in Australia. A self-administered questionnaire was completed at around 16 weeks of gestation. Height measured at baseline and self-reported pre-pregnancy weight were used to calculate body mass index. Cross-sectional analysis was conducted.Differences between groups were assessed using chi-squared tests for categorical variables and t-tests or Mann-Whitney U tests for continuous variables depending on distribution. Excess gestational weight gain (GWG) during pregnancy was more important in leading to health problems for women or their child compared with pre-pregnancy weight. Personal risk perception for complications was low for all women, although overweight women had slightly higher scores than healthy-weight women (2.4±1.0 vs 2.9±1.0 P<0.001). All women perceived their risk for complications to be below that of an average pregnant woman. Women should be informed of the risk associated with their pre-pregnancy weight (in the case of maternal overweight) and excess GWG. If efforts to raise risk awareness are to result in preventative action, this information needs to be accompanied by advice and appropriate support on how to reduce risk.
Publisher: Wiley
Date: 06-10-2022
DOI: 10.1111/AJR.12925
Abstract: To describe: (1) the type and frequency of interventions undertaken by regional cancer specialist Allied Health Professionals (AHPs) and (2) regional generalist AHPs' exposure and confidence in undertaking these interventions. Multiphase, observational study including a prospective study and a cross‐sectional survey. Two regional Queensland Hospitals. Cancer specialist AHPs ( n = 13 in a prospective study n = 7 in a cross‐sectional survey) and generalist AHPs ( n = 36 in a cross‐sectional survey), across six disciplines from two regional hospitals and cancer services. Phase 1: Frequency of cancer care AHP occasions of service and interventions. Phase 2: Current practice in cancer care AHP interventions confidence access to training, professional development and mentorship barriers to working in cancer care, among cancer care and generalist AHPs. Over 10‐months, cancer care AHPs collectively delivered 12 393 interventions across 8850 occasions of service. Only four cancer care interventions were exclusively or predominantly carried out by cancer care AHPs—laryngectomy pre‐operative counselling, laryngectomy rehabilitation and tracheostomy management (speech pathology) and lymphoedema management (physiotherapy). Generalist AHPs reported slightly lower confidence across all tasks if asked to carry out known interventions in a cancer setting compared with familiar settings. The primary perceived barrier to working in cancer care was lack of skills/experience/training reported by most CC AHPs, generalist Physiotherapists and Speech Pathologists, but not other generalist AHPs. There was a significant overlap in interventions undertaken in the cancer care and generalist setting for AHPs. Appropriate on‐boarding to contextualise interventions to cancer care is recommended to overcome reported lower confidence.
Publisher: American Physiological Society
Date: 09-2003
DOI: 10.1152/JAPPLPHYSIOL.00179.2003
Abstract: Carbohydrate (CHO) ingestion during exercise has been shown to reduce perturbations in immune cell numbers and function, possibly through a reduction in the cortisol response to exercise. We have previously observed that exercise decreases T-lymphocyte responses to mitogen via an increase in cell death of both CD4 and CD8 T lymphocytes (Green KJ and Rowbottom DG. J Appl Physiol. 95: 57-63, 2003). This study tested the hypothesis that CHO ingestion rather than placebo (Pl) would result in an attenuation of the cortisol response to exercise and a reduction of the exercise-associated alterations in cell death. Six well-trained cyclists completed two exercise trials consisting of 2.5 h of cycling at 85% of in idual ventilatory threshold. In a random order, trials were completed under either CHO (6% CHO solution, 3.2 g CHO/kg body wt total) or Pl conditions. Blood s les were collected before exercise, midexercise (after 60 min of exercise), immediately after exercise, and after 60 min of recovery. T-lymphocyte responses to mitogen were determined by using carboxyfluorescein diacetate succinimidyl ester fluorescent cell ision tracking and expansion rates, and cell death rates were calculated for each s le as well as mitosis rates for each cell generation. Cellular expansion of T lymphocytes was decreased after exercise in Pl only. The reduction in cellular expansion was related to an increase in cell death of both CD4 and CD8 cells in culture rather than a decrease in the ability of cells to undergo mitosis. CHO ingestion compared with Pl was associated with no reductions in cellular expansion or increases in cell death. CHO ingestion during exercise acted to reduce the impairment of T-lymphocyte function by decreasing cell death within mitogen-stimulated cell cultures however, the mechanism of action appears to be independent of cortisol.
Publisher: Wiley
Date: 30-03-2023
Abstract: Modifiable behaviours during the first 1000 days of life influence developmental trajectories of adult chronic diseases. Despite this, sub‐optimal dietary intakes during pregnancy and excessive gestational weight gain are common. Very little is known about partners' dietary patterns and the influence on women's pregnancy dietary patterns. We aimed to examine dietary intake during pregnancy among women and their partners, and gestational weight gain patterns in the Queensland Family Cohort pilot study. The Queensland Family Cohort is a prospective, observational study piloted at a Brisbane (Australia) tertiary maternity hospital from 2018 to 2021. Participant characteristics, weight gain, dietary and nutrient intake were assessed. Data were available for 194 pregnant women and their partners. Poor alignment with Australian Guide to Healthy Eating recommendations was observed. Highest alignment was for fruit (40% women) and meat/alternatives (38% partners) and lowest for breads/cereals ( % women) and milk/alternatives (13% partners). Fewer women (4.4%–60.3%) than their partners (5.4%–92.3%) met guidelines for all micronutrient intakes from food alone, particularly folic acid, iodine, and iron. Women were more likely to meet daily recommendations for fruit, vegetables, dairy, bread/cereals, and meat/alternatives when their partners also met recommendations. Women with a higher pre‐pregnancy body mass index were more likely to gain above recommended weight gain ranges. In this contemporary cohort of pregnant women and their partners, sub‐optimal dietary patterns and deficits in some nutrients were common. There is an urgent need for evidence‐informed public health policy and programs to improve diet quality during pregnancy due to intergenerational effects.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Springer Science and Business Media LLC
Date: 03-05-2022
DOI: 10.1186/S12913-022-08002-5
Abstract: Excess gestational weight gain (GWG) is associated with short-term perinatal complications and longer term cardiometabolic risks for mothers and their babies. Dietitian counselling and weight gain monitoring for women at risk of high pregnancy weight gain is recommended by clinical practice guidelines. However, face-to-face appointments, during a time with high appointment burden, can introduce barriers to engaging with care. Telephone counselling may offer a solution. The Living Well during Pregnancy (LWdP) program is a dietitian-delivered telephone coaching program implemented within routine antenatal care for women at risk of excess GWG. This program evaluation used a hybrid implementation-effectiveness design guided by the RE-AIM framework to report on the primary outcomes (reach, adoption, implementation, maintenance) and secondary outcomes (effectiveness) of the LWdP intervention. The LWdP program evaluation compared data from women participating in the LWdP program with a historical comparison group (pregnant women receiving dietetic counselling for GWG in the 12 months prior to the study). The primary outcomes were described for the LWdP program. Between group comparisons were used to determine effectiveness of achieving appropriate GWG and pre and post intervention comparisons of LWdP participants was used to determine changes to dietary intake and physical activity. The LWdP intervention group ( n = 142) were compared with women in the historical comparison group ( n = 49). Women in the LWdP intervention group attended 3.4 (95% CI 2.9–3.8) appointments compared with 1.9 (95% CI, 1.6–2.2) in the historical comparison group. GWG was similar between the two groups, including the proportion of women gaining weight above the Institute of Medicine recommendations (70% vs 73%, p = 0.69). Within group comparison showed that total diet quality, intake of fruit and vegetables and weekly physical activity were all significantly improved from baseline to follow-up for the women in LWdP, while consumption of discretionary food and time spent being sedentary decreased (all p 0.05). The LWdP program resulted in more women accessing care and positive improvements in diet quality, intuitive eating behaviours and physical activity. It was as effective as face-to-face appointments for GWG, though more research is required to identify how to engage women earlier in pregnancy and reduce appointment burden.
Publisher: Wiley
Date: 04-2019
Abstract: This study aimed to determine satisfaction with dietetic services, identify barriers and enablers to engaging with dietetic services and acceptable methods of delivering nutrition care to patients on haemodialysis. A questionnaire was developed based on existing satisfaction surveys and key constructs from the Theoretical Domains Framework to understand patient behaviours around accessing dietetic services. Constructs were grouped according to the COM-B model (Capability, Opportunity and Motivation) of the Behaviour Change Wheel to inform future interventions. Patients at three Brisbane haemodialysis units participated, with questionnaire administered via laptop (by dietetic assistants) or paper-based version (by nurses). Sixty-six patients completed the questionnaire (response rate 40%, 62 ± 14 years, 58% male). Most respondents (n = 63, 95%) reported seeing a dietitian since commencing haemodialysis. A quarter of respondents reported declining or not wanting to see the dietitian. Despite this, questions pertaining to service satisfaction were largely positive. Questions related to enablers and barriers to engaging with the dietitian revealed the domain of motivation as the main barrier with 41% (n = 26) participants not wanting to make dietary changes. The domains of capability and opportunity were not barriers. Patients preferred receiving nutrition information from dietitians, when they had a question or concern, rather than at predefined intervals. Telehealth was not acceptable to the majority of participants. While patients were satisfied with dietetic care, their preferences for dietetic service delivery were not aligned with current evidence-based guidelines, highlighting need for alternative models of care. Dietetic interventions need to be delivered in a way that addresses motivation.
Publisher: Informa UK Limited
Date: 02-07-2018
DOI: 10.1080/21551197.2018.1483281
Abstract: This pilot study evaluated the introduction of a bistro evening meal service in a geriatric inpatient unit by comparing patient intake, satisfaction and meal quality of this new service to the usual central preplated service. Ten meals were observed under each condition (n = 30 mean age 79 years, 47% male). Data were collected on intake of each meal component (none, ¼, ½, ¾, all converted to energy and protein using known food composition data), patient satisfaction with meals (meal flavor/taste, appearance, quality, staff demeanor seven-point scale) and meal quality (sensory properties, temperature five-point scale). Independent t-tests were used to compare energy and protein intakes between bistro and preplated services. There was no difference in mean energy or protein intake (energy: 2524 ± 927 kJ vs. 2692 ± 857 kJ, p = 0.612 protein: 29 ± 12 g vs. 27 ± 11 g, p = 0.699) patient satisfaction or meal quality between the bistro and preplated meal services. Patients were provided with fewer meal items during the bistro service, but ate a higher proportion of what was provided to them. Implementing a bistro service did not increase intake, satisfaction or meal quality in this study, suggesting that meal plating may be only one of many factors influencing intake and satisfaction of older inpatients.
Publisher: Wiley
Date: 21-02-2020
DOI: 10.1111/AJO.13128
Publisher: Wiley
Date: 12-08-2022
DOI: 10.1111/AJO.13601
Abstract: There is no international consensus for the screening and diagnosis of gestational diabetes mellitus (GDM). In March 2020, modified screening and diagnostic recommendations were rapidly implemented in Queensland, Australia, in response to the COVID‐19 pandemic. How clinicians perceived and used these changes can provide insights to support high‐quality clinical practice and provide lessons for future policy changes. The aim of this study was to understand clinicians' perceptions and use of COVID‐19 changes to GDM screening and diagnostic recommendations. Queensland healthcare professionals responsible for diagnosing or caring for women with GDM were recruited for semi‐structured telephone interviews. Data analysis of transcribed interviews used inductive reflexive thematic analysis. Seventeen interviews were conducted with the following participants: six midwives/nurses, three endocrinologists, two general practitioners, two general practitioners/obstetricians, two diabetes educators, one dietitian and one obstetrician. Three themes emerged: communication and implementation, perceptions and value of evidence and ersity in perceptions of GDM screening. Overall, clinicians welcomed the rapid changes during the initial uncertainty of the pandemic, but as COVID‐19 became less of a threat to the Queensland healthcare system, some questioned the underlying evidence base. In areas where GDM was more prevalent, clinicians more frequently worried about missed diagnoses, whereas others who felt that overdiagnosis had occurred in the past continued to support the changes. These findings highlight the challenges to changing policy when clinicians have erse (and often strongly held) views.
Publisher: Wiley
Date: 12-08-2022
DOI: 10.1111/AJO.13600
Abstract: Consumer perspectives are a cornerstone of value‐based healthcare. Screening and diagnosis of gestational diabetes mellitus (GDM) were among many of the rapid changes to health care recommended during the COVID‐19 pandemic. The changes provided a unique opportunity to add information about women's perspectives on the debate on GDM screening. The aim of this qualitative study was to explore women's perspectives and understanding of GDM screening and diagnosis comparing the modified COVID‐19 recommendations to standard GDM screening and diagnostic practices. Women who had experienced both the standard and modified GDM screening and diagnostic processes were recruited for telephone interviews. Data analysis used inductive reflexive thematic analysis. Online surveys were disseminated to any registrant not included in interviews to provide an opportunity for all interested participants to provide their perspective. Twenty‐nine telephone interviews were conducted and 19 survey responses were received. Seven themes were determined: (1) information provision from clinicians (2) acceptability of GDM screening (3) in idualisation of GDM screening methods (4) safety nets to avoid a missed diagnosis (5) informed decision making (6) women want information and evidence and (7) preferred GDM screening methods for the future. Overall, women preferred the modified GDM screening recommendations put in place due to the COVID‐19 pandemic. However, their preference was influenced by their prior screening experience and perception of personal risk profile. Women expressed a strong need for clear communication from health professionals and the opportunity to be active participants in decision making.
Publisher: Georg Thieme Verlag KG
Date: 11-2020
Abstract: Gestational diabetes mellitus (GDM) is a common pregnancy disorder and the incidence is increasing worldwide. GDM is associated with adverse maternal outcomes which may be reduced with proper management. Lifestyle modification in the form of medical nutrition therapy and physical activity, as well as self-monitoring of blood glucose levels, is the cornerstone of GDM management. Inevitably, the search for the “ultimate” diet prescription has been ongoing. Identifying the amount and type of carbohydrate to maintain blood glucose levels below targets while balancing the nutritional requirements of pregnancy and achieving gestational weight gain within recommendations is challenging. Recent developments in the area of the gut microbiota and its impact on glycemic response add another layer of complexity to the success of medical nutrition therapy. This review critically explores the challenges to dietary prescription for GDM and why utopia may never be found.
Publisher: SAGE Publications
Date: 05-10-2022
DOI: 10.1177/08903344221126644
Abstract: The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life and that breastfeeding should continue for 2 years and beyond. Most women initiate breastfeeding, but many do not continue for the recommended duration. While midwife-led continuity of antenatal care is linked to improved mother and infant outcomes, the influence on breastfeeding duration has not been previously reviewed. To critically analyze the literature that compared midwife-led continuity of antenatal care with other models of care where researchers have measured breastfeeding duration beyond postpartum hospital discharge. A systematic literature review with critical analysis was used to answer the research aim. We systematically searched and screened five databases for quantitative studies where researchers had reported breastfeeding duration beyond postpartum hospital discharge after midwife-led continuity of antenatal care, compared with another model of antenatal care. Methodological quality was assessed using tools from the Cochrane Collaboration (RoB2 and ROBINS-I). In total, nine studies met the inclusion criteria. Clear conclusions about the association between midwife-led continuity of antenatal care and breastfeeding duration were not found. The risk of bias within non-randomized studies ranged from serious to critical, and a judgement of “some concerns” of risk of bias in the one randomized study. To date, the question of whether midwife-led continuity of antenatal care improves breastfeeding duration has not been established. There has been a lack of consistency in definitions of breastfeeding and descriptions of models of care, which has weakened the evidence-based of literature reviewed. Our review protocol was registered with PROSPERO although due to COVID-19, this registration was not checked for eligibility by the PROSPERO team (CRD42020151276). www.crd.york.ac.uk rospero/display_record.php?ID=CRD42020151276
Publisher: Springer Science and Business Media LLC
Date: 17-08-2018
DOI: 10.1007/S11695-018-3392-8
Abstract: The restrictive and/or malabsorptive nature of bariatric surgery may increase the risk for micronutrient deficiencies. This systematic review aimed to identify and critique the evidence for vitamin A, B1, C or E deficiencies associated with bariatric surgery. This review utilised PRISMA and MOOSE frameworks with NHMRC evidence hierarchy and the American Dietetic Association bias tool to assess the quality of articles. Twenty-one articles were included and once critiqued all studies were of level IV grade and neutral or negative in quality. The relevance of measuring micronutrient supplementation and inflammatory markers for validity of serum vitamins is absent within the literature. Future research is needed to investigate the risk of deficiency for these procedures with focus on confounders to serum micronutrients.
Publisher: Wiley
Date: 10-07-2019
DOI: 10.1111/AJO.13032
Abstract: In 2014, updated screening and diagnostic criteria for gestational diabetes (GDM) were introduced across Australia. Many states including Queensland introduced clinical guidelines to include these changes and other recommendations for GDM management. While it is understood that GDM diagnosis has increased, it is unknown whether resources or service delivery have changed, or whether health services have implemented the guidelines. To understand the staff resourcing, models of care, level of guideline implementation and barriers and enablers to implementing the guideline across Queensland Health GDM services. A 22-item electronic survey containing multiple choice and open-ended questions was disseminated to healthcare professionals involved in GDM care across 14 Hospital and Health Services (HHS) in Queensland between August and October 2017. Fifty-three surveys were included for analysis. Between 2014 and 2016, Queensland GDM diagnosis increased by an average of 33%, yet only eight out of 14 HHS reported increases to staff resourcing. Full implementation of the GDM guideline was reported by 41% of metropolitan compared with 29% for regional and 25% for rural/remote services. Guideline recommendations were inconsistently delivered for physical activity advice, minimum schedule of dietetics appointments and psychosocial support. The most common barrier to guideline implementation was staff resourcing (85%), whereas enablers included staff/teamwork (42%), staff resourcing (21%), local protocols (21%) and staff education/knowledge (15%). Increased staff funding as well as an implementation science-driven process for guideline implementation is required to ensure that the increasing number of women with GDM can receive evidence-based care.
Publisher: The Royal Australian College of General Practitioners
Date: 03-2022
Publisher: Georg Thieme Verlag KG
Date: 11-2021
Abstract: Gestational diabetes mellitus (GDM) is the most common complication of pregnancy and a significant clinical and public health problem with lifelong and intergenerational adverse health consequences for mothers and their offspring. The preconception, early pregnancy, and interconception periods represent opportune windows to engage women in preventive and health promotion interventions. This review provides an overview of findings from observational and intervention studies on the role of diet, physical activity, and weight (change) during these periods in the primary prevention of GDM. Current evidence suggests that supporting women to increase physical activity and achieve appropriate weight gain during early pregnancy and enabling women to optimize their weight and health behaviors prior to and between pregnancies have the potential to reduce rates of GDM. Translation of current evidence into practice requires further development and evaluation of co-designed interventions across community, health service, and policy levels to determine how women can be reached and supported to optimize their health behaviors before, during, and between pregnancies to reduce GDM risk.
Publisher: Research Square Platform LLC
Date: 03-01-2022
DOI: 10.21203/RS.3.RS-1143454/V1
Abstract: Background Excess gestational weight gain (GWG) is associated with short-term perinatal complications and longer term cardiometabolic risks for mothers and their babies. Dietitian counselling and weight gain monitoring for women at risk of high pregnancy weight gain is recommended by clinical practice guidelines. However, face-to-face appointments, during a time with high appointment burden, can introduce barriers to engaging with care. Telephone counselling may offer a solution. The Living Well during Pregnancy (LWdP) program is a dietitian-delivered telephone coaching program implemented within routine antenatal care for women at risk of excess GWG. This program evaluation used a hybrid implementation-effectiveness design guided by the RE-AIM framework reports on the primary outcomes (reach, adoption, implementation, maintenance) and secondary outcomes (effectiveness) of the LWdP intervention. Methods The LWdP program evaluation compared data from women participating in the LWdP program with a historical comparison group (pregnant women receiving dietetic counselling for GWG in the 12 months prior to the study). The primary outcomes were described for the LWdP program. Between group comparisons were used to determine effectiveness of achieving appropriate GWG and pre and post intervention comparisons of LWdP participants was used to determine changes to dietary intake and physical activity. Results The LWdP intervention group (n=142) were compared with women in the historical comparison group (n=49). Women in the LWdP intervention group attended 3.4 (95% CI 2.9 – 3.8) appointments compared with 1.9 (95% CI, 1.6 – 2.2). GWG was similar between the two groups, including the proportion of women gaining weight above the Institute of Medicine recommendations (70% vs 73%, p=0.69). Within group comparison showed that total diet quality, intake of fruit and vegetables and weekly physical activity were all significantly improved from baseline to follow-up for the women in the LWdP, while consumption of discretionary food and time spent being sedentary decreased (all p .05). Conclusion The LWdP program resulted in more women accessing care and positive improvements in diet quality, intuitive eating behaviours and physical activity. It was as effective as face-to-face appointments for GWG, though more research is required to identify how to engage women earlier in pregnancy and reduce appointment burden.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Research Square Platform LLC
Date: 19-01-2023
DOI: 10.21203/RS.3.RS-2485814/V1
Abstract: Background: The aim of this study was to calculate the cost-effectiveness of a telehealth coaching intervention to reduce GDM and to calculate the breakeven point of reducing GDM. Methods: Data to inform the economic evaluation model was sourced directly from the large quaternary hospital in Brisbane, where the Living Well during Pregnancy (LWdP) program was implemented and further supplemented with literature-based estimates where data had not been directly collected in the trial. A cost-effectiveness model was developed using a decision tree framework to estimate the potential for cost savings and quality of life improvement. A total of 3,578 pregnant people (mean age 30.9 + 5.3 years, 18.8% BMI 25-29.9, 18.6% BMI 30kg/m 2 67.4% multiparous) were included in the analyses. Results: The cost of providing routine care and routine care plus LWdP intervention to pregnant women was calculated to be AUD 22,827 and AUD 22,537, respectively. The effectiveness of LWdP program (0.894 utility) is slightly higher compared to routine care (0.893). Therefore, the value of ICER is negative and it indicates that the LWdP program is a dominant strategy to reduce GDM in pregnant women. We also performed probabilistic sensitivity analysis using Monte Carlo simulation over 1,000 simulations. The ICE scatter plot showed that LWdP intervention is dominant over routine care in 99.60% of the trials using a willingness to pay threshold of AUD 50,000. Conclusions: Findings support consideration by healthcare policy and decision makers of telehealth and broad-reach delivery of structured lifestyle interventions during pregnancy to lower short-term costs associated with GDM to the health system.
Publisher: SAGE Publications
Date: 2021
DOI: 10.1177/26334941211031866
Abstract: Women with maternal obesity, an unhealthy lifestyle before and during pregnancy and excess gestational weight gain have an increased risk of adverse pregnancy and birth outcomes that can also increase the risk of long-term poor health for them and their children. Pregnant women have frequent medical appointments and are highly receptive to health advice. Healthcare professionals who interact with women during pregnancy are in a privileged position to support women to make lasting healthy lifestyle changes that can improve gestational weight gain and pregnancy outcomes and halt the intergenerational nature of obesity. Midwives and obstetrical nurses are key healthcare professionals responsible for providing antenatal care in most countries. Therefore, it is crucial for them to build and enhance their ability to promote healthy lifestyles in pregnant women. Undergraduate midwifery curricula usually lack sufficient lifestyle content to provide emerging midwives and obstetrical nurses with the knowledge, skills, and confidence to effectively assess and support healthy lifestyle behaviours in pregnant women. Consequently, registered midwives and obstetrical nurses may not recognise their role in healthy lifestyle promotion specific to healthy eating and physical activity in practice. In addition, practising midwives and obstetrical nurses do not consistently have access to healthy lifestyle promotion training in the workplace. Therefore, many midwives and obstetrical nurses may not have the confidence and/or skills to support pregnant women to improve their lifestyles. This narrative review summarises the role of midwives and obstetrical nurses in the promotion of healthy lifestyles relating to healthy eating and physical activity and optimising weight in pregnancy, the barriers that they face to deliver optimal care and an overview of what we know works when supporting midwives and obstetrical nurses in their role to support women in achieving a healthy lifestyle.
Publisher: SAGE Publications
Date: 06-07-2022
DOI: 10.1177/1753495X221106085
Abstract: Pregnancy following bariatric surgery requires tailored care. The current Australian care provision and its alignment with consensus guidelines is unclear. Antenatal care clinicians were invited to complete a web-based survey assessing multidisciplinary referral, gestational diabetes mellitus (GDM) and micronutrient management practices. Respondents (n = 100) cared for pregnant women with a history of bariatric surgery at least monthly (63%) with most (54%) not using a specific guideline to direct care. GDM screening methods included one-week of home blood glucose monitoring (43%) or the oral glucose tolerance test (42%). Pregnancy multivitamin supplementation changes (59%) with bariatric surgery type were common. Half (54%) screened for micronutrient deficiencies every trimester and conducted additional growth ultrasounds (50%). The care clinicians report providing may not align with current international consensus guidelines. Further studies with increased obstetric clinician response may aid increased understanding of current practices. The development of workplace management guidelines for pregnancy in women with a history of bariatric surgery may assist with providing consistent evidence-based care.
Publisher: CSIRO Publishing
Date: 16-11-2021
DOI: 10.1071/AH21173
Abstract: Objective The aims of this study were to determine whether a university–hospital partnership program for Type 2 diabetes (T2D) would: be well attended reduce the number of patients on the diabetes out-patient waiting list who have been waiting longer than the recommended increase discharge from the hospital clinic increase university health clinic (UHC) occasions of service be sustainable and be acceptable to participants. Method A prospective observational study was conducted between 2016 and 2019. Participants with T2D were referred to a UHC, initially from a hospital diabetes wait list. The final program consisted of 10 weeks: before and after in idual assessments, as well as 8 weeks of exercise and education facilitated by health professionals and students. Participant demographic characteristics and data on attendance, discharge and follow-up requirements, the percentage of patients waiting longer than the recommended for a new hospital out-patient appointment, university activity and patient satisfaction were collected. Results In all, 130 participants commenced the program, 80% completed at least six of eight group sessions and 80% attended the final assessment. The percentage of people waiting longer than recommended decreased from 63% to 16%. The hospital discharged 87% and 59% of participants from the dietitian and endocrinologist respectively. The UHC recorded 2056 occasions of service and 2056 student experiences including dietetics, exercise physiology, psychology, nursing, optometry, social work and podiatry students relating to the program. Satisfaction was high, as measured by the Short Assessment of Patient Satisfaction, with a mean score of 23.9 from a possible score of 28.0 (n = 93). Conclusion The partnership resulted in a new model of care for patients with T2D and increased learning experiences for students. What is known about the topic? Diabetes is the fastest growing disease in Australia, placing unsustainable demands on the health system. Access to patient-centred care and self-management education is essential to optimise glycaemic control, prevent or delay complications and maintain quality of life. The increasing demand of diabetes on the health system affects access to timely care, with unacceptably long wait times reported, resulting in an increase in morbidity and mortality and poor patient satisfaction. A potential solution is the use of clinical students to contribute to service delivery. Student-assisted and student-led health clinics have increased access to care across the globe for many years. What does the paper add? Although group education has the potential to reduce the burden on clinical service delivery, it was unclear whether a partnership program using students and university and hospital resources would be acceptable to people with T2D and whether this model delivered at a UHC would be sustainable and of benefit to both the health service and university. The results of the evaluation suggest that a university–hospital partnership program is well accepted by participants, well attended, reduces the number of patients waiting for a hospital appointment longer than the acceptable waiting times, increases UHC activity and provides interdisciplinary student experiences. As such, this paper provides evidence that this model of care offers a potential solution to increasing demands for health services for diabetes and student clinical experience. What are the implications for practitioners? Partnerships between UHCs and hospitals offer a sustainable solution to increasing demand for diabetes services and student training requirements. The description of the development, implementation and evaluation processes can be used by practitioners and educators as a framework for the translation of similar models of care to meet demands in other areas where demand for health services exceeds capacity.
Publisher: Research Square Platform LLC
Date: 20-01-2023
DOI: 10.21203/RS.3.RS-2367903/V1
Abstract: Background : Bariatric surgery may increase the risk of micronutrient deficiencies however, confounders including preoperative deficiency, supplementation and inflammation are rarely considered. Objective : To examine the impact of bariatric surgeries, supplementation and inflammation on micronutrient deficiency. Setting : Two public hospitals, Australia. Methods : Participants were recruited to an observational study monitoring biochemical micronutrient outcomes, supplementation dose, inflammation and glycemic control, pre-operatively and at 1-3, 6 and 12 months after gastric bypass (GB Roux-en-Y Gastric Bypass and Single Anastomosis Gastric Bypass N=66) or sleeve gastrectomy (SG N=144). Participant retention at 12 months was 81%. Results : Pre-operative micronutrient deficiency was common, for vitamin D (29-30%), iron (13-22%) and selenium (39% GB cohort). Supplement intake increased after surgery however, dose was % of target for most nutrients. After SG, folate was vulnerable to deficiency at 6-months (OR 13 [95% CI 2, 84] p=0.007), with folic acid supplementation being independently associated with reduced risk. Within 1-3 months of GB, three nutrients had higher deficiency rates compared to pre-operative levels vitamin B1 (21% vs. 6%, p .01), vitamin A (21% vs. 3%, p .01) and selenium (59% vs. 39%, p .05). Vitamin B1 deficiency was independently associated with surgery and inflammation, selenium deficiency with improved glycemic control after surgery and inflammation, whilst vitamin A deficiency was associated with inflammation only. Conclusion : In the setting of prophylactic post-surgical micronutrient prescription, few nutrients are at risk of de novo deficiency. Although micronutrient supplementation and monitoring remains important, rationalising high frequency biochemical testing protocols in the first year after surgery may be warranted.
Publisher: Wiley
Date: 06-08-2023
Abstract: This study aimed to explore the multidisciplinary team attitudes and knowledge of bariatric surgery micronutrient management (pre‐ and postoperative care) and to evaluate the implementation of an extended‐scope of practice dietitian‐led model of care for micronutrient monitoring and management. A mixed method study design included quantitative evaluation of micronutrient testing practices and deficiency rates. Qualitative reflexive thematic analysis was used to interpret multidisciplinary experience with micronutrient monitoring in a traditional and dietitian‐led model of care. In addition, deductive analysis used normalisation process theory mapping of multidisciplinary experience with the implementation of the dietitian‐led model of care. In the traditional model, a lack of quality evidence to guide micronutrient management, and a tension in trust between surgeons and patients related to adherence to micronutrient prescriptions were described as challenges in current practice. The dietitian‐led model was seen to overcome some of these challenges, increasing collaborative, and coordinated, consistent and personalised patient care that led to increased testing for and detection of micronutrient deficiencies. Barriers to sustainability of the dietitian‐led model included a lack of workforce succession planning, and no clearly defined delegation for some aspects of care. An extended scope dietitian‐led model of care for micronutrient management after bariatric surgery improves clinical care. Challenges such as succession planning must be considered in design of extended scope services.
Publisher: Wiley
Date: 13-03-2019
Publisher: Wiley
Date: 21-03-2016
DOI: 10.1111/JAN.12940
Abstract: To evaluate the impact of mealtime practices (meal time preparation, assistance and interruptions) on meal intake of inpatients in acute hospital wards. It is common for patients to eat poorly while in hospital, related to patient and illness factors and possibly mealtime practices. Few studies have quantified the impact of mealtime practices on the meal intake of hospital patients. Cross-sectional study. Structured observations were conducted at 601 meals across four wards (oncology, medical and orthopaedic and vascular surgical) during 2013. Each ward was observed by two dietitians and/or nurses for two breakfasts, lunches and dinners over 2 weeks. Data were collected on patient positioning, mealtime assistance, interruptions and meal intake (visual estimate of plate waste). Associations between mealtime practices and 'good' intake (prospectively defined as ≥75% of meal) were identified using chi-squared tests. Sitting up for the meal was associated with good intake, compared with lying in bed. Timely mealtime assistance (within 10 minutes) was associated with good intake, compared with delayed or no assistance. Mealtime interruptions had no impact on intake. Forty percent of patients (n = 241) ate half or less of their meal, with 10% (n = 61) eating none of the meal provided. Timely mealtime assistance and positioning for the meal may be important factors that facilitate intake among hospital patients, while mealtime interruptions appeared to have no impact on intake. To improve intake of older inpatients, mealtime programmes should focus on 'assisted mealtimes' rather than only Protected Mealtimes.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.MIDW.2018.06.025
Abstract: To examine if a brief midwifery education and training session incorporated into annual mandatory training improves the knowledge and confidence of midwives to support healthy weight gain and management in pregnancy. An implementation evaluation using a pre-post study design was used. Midwives completed a self- administered questionnaire prior to and following completion of the training session. Objective knowledge, perceived knowledge and confidence in relation to nutrition, physical activity and healthy weight gain and management, and process measures related to the training were assessed. All midwives from a tertiary birthing hospital in Brisbane Australia who attended the annual mandatory training day in 2015 were invited to participate. Of the 270 midwives who attended the training 154 pre and 114 post training questionnaires were returned. An increase in perceived knowledge across topic areas was reported by 70-97% of respondents, while perceived confidence increased for 83-91% of respondents across each topic area. Objective knowledge score increased from 11 pre-training to 15 post training (maximum score 17) (p < 0.001). Ninety six percent of respondents agreed the training provided practical communication strategies and 100% would recommend the training to others. This brief education session integrated into an existing mandatory training program, improved the knowledge and confidence of midwives in delivering advice and support for healthy pregnancy weight gain. This improvement is the first step in changing practice to prevent excess weight gain during the antenatal period. This program offers an innovative model to support midwives implement change across other health services. A low cost intervention that was well received by midwives can address identified barriers to the provision of best practice care that supports a healthy pregnancy weight gain in a sustainable forum.
Publisher: Springer Science and Business Media LLC
Date: 03-11-2020
DOI: 10.1186/S12884-020-03352-6
Abstract: There is strong evidence that women with gestational diabetes mellitus (GDM) who receive a minimum of three appointments with a dietitian may require medication less often. The aim of this study was to evaluate the impact of a dietitian-led model of care on clinical outcomes and to understand the utility of the integrated Promoting Action on Research Implementation in Health Services ( i -PARIHS) framework as a prospective tool for implementation. This was a pre-post intervention study measuring outcomes before-and-after changing a gestational diabetes (GDM) model of care and included women with GDM managed at a large, regional hospital in Queensland, Australia. The i -PARIHS framework was used to develop, implement and evaluate a dietitian-led model of care which increased dietetic input for women with GDM to a minimum of one initial education and two review appointments. The outcomes were adherence to the schedule of appointments, clinician perspective of the implementation process, pharmacotherapy use, gestational age at commencement of pharmacotherapy and birth weight. Pre- and post- comparisons of outcomes were made using t-tests and chi-squared tests. Adherence to the dietetic schedule of appointments was significantly increased from 29 to 82% ( p 0.001) but pharmacotherapy use also increased by 10% ( p = 0.10). There were significantly more women in the post-intervention group who were diagnosed with GDM prior to 24 weeks gestation, a strong independent predictor of pharmacotherapy use. Infant birthweight remained unchanged. The i -PARIHS framework was used as a diagnostic tool and checklist in the model of care development phase a facilitation tool during the implementation phase and during the evaluation phase was used as a reflection tool to identify how the i- PARIHS constructs and their interactions that may have impacted on clinical outcomes. The i -PARIHS framework was found to be useful in the development, implementation and evaluation of a dietitian-led model of care which saw almost 90% of women with GDM meet the minimum schedule of dietetic appointments.
Publisher: Springer Science and Business Media LLC
Date: 22-04-2023
DOI: 10.1007/S11695-023-06565-8
Abstract: The aim of this review was to report on maternal diet, micronutrient supplementation, and gestational weight gain (GWG) during pregnancy following bariatric surgery and explore the impact on maternal micronutrient deficiency, offspring growth, and perinatal outcomes. A search in PubMed, CINAHL, EMBASE, and ProQuest in July 2022 returned 23 eligible studies ( n = 30–20, 213). Diet was reported in two studies, supplementation in six and GWG in 19 studies. Although many women did not achieve healthy GWG, no consistent link with adverse outcomes was reported. Studies were grades II and III on the National Health and Medical Research Council evidence hierarchy and received a neutral or negative score on the Academy of Nutrition and Dietetics Quality Criteria Checklist, suggesting that methodological limitations impact the reliability of reported findings.
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.MIDW.2017.07.002
Abstract: Women with a higher BMI are at increased risk of breastfeeding for a shorter duration, however it is unclear if weight status itself or other factors such as feeding intentions are responsible for early breastfeeding cessation. The aim of this study was determine the influence of maternal pre-pregnancy weight status on infant feeding intentions during pregnancy using a validated scale and assess whether high intentions to exclusively breastfeed measured during pregnancy predicted feeding mode at discharge and at 4 months postpartum in both healthy weight (Hwt) (BMI< 25kg/m This prospective, observational study commenced when participants were <20 weeks gestation, continuing until four months post partum. Self-administered questionnaires assessed pre-pregnancy weight, infant feeding intentions at 36 weeks gestation, and breastfeeding practices at hospital discharge and 4 months postpartum. Hospital records provided details of delivery mode, gestation and breastfeeding during hospital stay. Binary logistic regression analyses were used to compare weight groups on the breastfeeding beliefs and practices adjusting for selected covariates PARTICIPANTS AND SETTING: A consecutive s le of pregnant women (n = 715) were recruited from an Australian metropolitan hospital between August 2010 and January 2011. All women <20 weeks gestation were eligible unless they had pre-existing Type 1 or 2 diabetes or insufficient English language skills to complete questionnaires. Of 715 women recruited, 402 had complete data at 4 months post-partum. There were no differences in high breastfeeding intentions (66% vs 53%, p = 0.10) or initiation (96% vs. 98%, p = 0.33) between Hwt and Owt women. Owt women were less likely to be exclusively breastfeeding at hospital discharge AOR [95%CI] 0.57 [0.33,0.98] and 4 months post-partum 0.62 [0.40,0.97]. High intention to breastfeed was positively associated with exclusively/fully breastfeeding at hospital discharge in Hwt 3.24 [1.52,6.89] but not Owt women 1.73 [0.75,4.00] and 4 months post partum in both weight groups (Hwt 4.1 [2.4-7.2], Owt 6.5 [2.9-14.3]). Healthy and overweight women appear to have similar antenatal intentions for infant feeding but overweight mothers are less likely to be exclusive breastfeeding at hospital discharge. High antenatal intentions for breastfeeding are related to exclusively/fully breastfeeding at 4 months post partum in both healthy and overweight women. Investigation of early hospital practices that support and hinder the establishment of successful breastfeeding in overweight mothers may help to identify effective strategies to protect breastfeeding relationships between mother-infant dyads, particularly those who have experienced a caesarean delivery.
Publisher: Wiley
Date: 21-09-2022
DOI: 10.1111/JHN.13082
Abstract: There is little known about nutrition intervention research involving consumer co‐design. The aim of this scoping review was to identify and synthesise the existing evidence on the current use and extent of consumer co‐design in nutrition interventions. This scoping review is in line with the methodological framework developed by Arksey and O'Malley and refined by the Joanna Briggs Institute using an adapted 2weekSR approach. We searched Medline, EMBASE, PsycInfo, CINAHL and Cochrane. Only studies that included consumers in the co‐design and met the ‘Collaborate’ or ‘Empower’ levels of the International Association of Public Participation's Public Participation Spectrum were included. Studies were synthesised according to two main concepts: (1) co‐design for (2) nutrition interventions. The initial search yielded 8157 articles, of which 19 studies were included (comprising 29 articles). The studies represented a range of intervention types and participants from seven countries. Sixteen studies were published in the past 5 years. Co‐design was most often used for intervention development, and only two studies reported a partnership with consumers across all stages of research. Overall, consumer involvement was not well documented. No preferred co‐design framework or approach was reported across the various studies. Consumer co‐design for nutrition interventions has become more frequent in recent years, but genuine partnerships with consumers across all stages of nutrition intervention research remain uncommon. There is an opportunity to improve the reporting of consumer involvement in co‐design and enable equal partnerships with consumers in nutrition research.
Publisher: JMIR Publications Inc.
Date: 24-02-2022
Abstract: igital health resources have the potential to assist women in optimising gestational weight gain (GWG) during pregnancy to improve maternal health outcomes. his study aims to evaluate the quality, credibility, safety and potential for health-related behaviour change of publicly available digital health tools that promote GWG management. igital tools were identified using key search terms across website search engines and application stores and evaluated using the Mobile App Rating Scale (MARS), the App Behaviour Change Scale (ABACUS) as well as criteria to evaluate the rigor and safety of GWG information. verall, 1,085 tools were screened for inclusion (n=162 websites and n=923 apps) and 19 were deemed eligible. The mean MARS quality score was 3.31 (0.53) out of 5, ranging from 2.26 to 4.39 and the mean ABACUS score was 6 (3.4) out of 21 ranging from 19 to 0. Of 19 items to evaluate rigour of GWG advice, the majority of tools (n=11, 57.9%) contained three items or less overall. his review emphasises significant limitations in current digital resources promoting monitoring and optimisation for GWG. The majority of tools were of low quality, had minimal behaviour change potential and were potentially unsafe, with minimal linkage to evidence-based information or partnership with healthcare.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-03-2023
DOI: 10.1097/XEB.0000000000000369
Abstract: Excess gestational weight gain is a challenge within antenatal care. Low-intensity interventions that offer opportunities for in idualization, such as pregnancy weight-gain charts (PWGCs) combined with brief advice, have been a promising strategy but scaling out such interventions requires planning. The aim of this study was to examine current practices and conduct a context assessment using the Consolidated Framework for Implementation Research (CFIR) to guide implementation of PWGCs and brief intervention advice to support healthy pregnancy weight gain in two hospitals that provide antenatal care. Retrospective chart audits and surveys of staff and women were used to understand current practice as well as barriers and enablers to implementing change according to the domains and constructs reported in the CFIR. Forty-eight percent (site A) and 46% (site B) of pregnant women who were audited ( n = 180, site A n = 176, site B) gained weight above recommendations. Most women were unable to accurately report their recommended weight gain for pregnancy (93% site A, 94% site B). Although more than 50% of women reported discussions about weight gain during pregnancy, advice about physical activity and healthy eating (in the context of helping women to achieve healthy gestational weight gain) was low. Mapping barriers and enablers to the CFIR helped guide the selection of implementation strategies, including audit and feedback, informing local opinion leaders, obtaining consensus, identifying ch ions, and building a coalition. Scaling out of interventions can be enhanced by undertaking a detailed context assessment guided by implementation frameworks.
Publisher: Wiley
Date: 18-04-2018
DOI: 10.1111/AJO.12816
Abstract: Gestational diabetes mellitus (GDM) is one of the most common pregnancy disorders however, if well managed, women with GDM experience similar pregnancy outcomes to those without. Currently, there is limited evidence on actual management practices across Australia or how multidisciplinary teams interact to optimise care. To examine the current screening, diagnostic, task and role perceptions and management practices, as reported by members of the GDM multidisciplinary team. A 64-item electronic survey containing multiple choice, Likert scale and open-ended questions was developed for this cross-sectional observational study and advertised through health professional organisations and Queensland Health facilities in May and June, 2017. The 183 survey respondents included 45 diabetes educators, 43 dietitians, 21 endocrinologists/diabetes specialists, 14 obstetricians and 21 midwives. Although almost 90% reported using updated diagnostic guidelines, less than two-thirds used GDM management guidelines. While 68% reported using the same blood glucose targets for GDM management, there was variation to what criteria prompted the commencement of medication to control blood glucose levels. There was a good consensus concerning the health professional responsible for tasks such as medical nutrition therapy, gestational weight gain and self-blood glucose monitoring education and ultrasound use. Other tasks appeared to be the role of almost any member of the GDM multidisciplinary team. The survey results indicate there is a need for consistent evidence on how to best manage GDM and that role identity, access to specialist knowledge and best practice need to be clearly defined within GDM models of care.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2020
DOI: 10.1097/AOG.0000000000003790
Abstract: To evaluate the effects of updated gestational diabetes mellitus (GDM) screening and diagnostic criteria on selected perinatal outcomes in Queensland, Australia. This was a pre–post comparison study using perinatal data the year before (2014) and after (2016) the screening and diagnostic criteria for GDM was changed in Queensland, Australia. In 2015, Queensland adopted the one-step screening and diagnostic criteria based on the International Association of the Diabetes and Pregnancy Study Groups' recommendations. The data from 62,517 women in 2014 and 61,600 women in 2016 who gave birth from 24 weeks of gestation were analyzed in three groups in each year: women with GDM women without diagnosed GDM and total population. The outcome measures were gestational hypertension, cesarean birth, gestational age at delivery, birth weight, preterm delivery, large-for-gestational age (LGA) neonates, small-for-gestational-age (SGA) neonates, neonatal hypoglycemia, and respiratory distress. The diagnosis of GDM increased from 8.7% (n=5,462) to 11.9% (n=7,317). After changing the diagnostic criteria, the changes to outcomes, odds ratios (OR), and adjusted odds ratios (aOR) (95% CI) for outcomes with statistically significant differences for the total population were: gestational hypertension 4.6% vs 5.0%, OR 1.09 (1.03–1.15), aOR 1.07 (1.02–1.13) preterm birth 7.6% vs 8.0%, OR 1.05 (1.01–1.09), aOR 1.06 (1.02–1.10) neonatal hypoglycemia 5.3% vs 6.8%, OR 1.31 (1.25–1.37), aOR 1.32 (1.25–1.38) and respiratory distress 6.2% vs 6.0%, OR 0.96 (0.91–1.00), aOR 0.94 (0.89–0.99). There was no change to cesarean births or LGA or SGA neonates for women with or without diagnosed GDM or the total population. Except for a very small decrease in respiratory distress, changing the diagnostic criteria has resulted in more GDM diagnoses with no observed changes to measured perinatal outcomes for women with and without diagnosed GDM.
Publisher: Wiley
Date: 27-03-2022
DOI: 10.1111/AJO.13509
Abstract: Consensus‐based recommendations guiding oral intake during labour are lacking. We surveyed women at a tertiary women’s hospital about preferences for and experiences of oral intake during labour, gastrointestinal symptoms during labour and recalled advice about oral intake. Women who experienced labour completed a postpartum survey with responses as free text, yes‐no questions and five‐point Likert scales. We identified demographic data and risk factors for surgical or anaesthetic intervention at delivery from medical records. We summarised free text comments using conventional content analysis. One hundred and forty‐nine women completed the survey (47% response rate). Their mean (SD) age was 31 (four) years, birthing at median gestation of 39 weeks (interquartile range: 38‐40). One hundred and twenty‐two (83%) and 44 (30%) women strongly agreed or agreed they felt like drinking and eating respectively during labour. Ninety women (61%) reported nausea and 47 women (32%) reported vomiting in labour. Forty‐one women (28%) did not receive advice on oral intake during labour. Maternal risk factors for surgical intervention were identified in 72 (48%) women and fetal risk factors in 27 (18%) women. Thirty‐one women (21%) delivered by emergency caesarean section. Pregnant women received variable advice regarding oral intake during labour, from variable sources. Most women felt like drinking but not eating during labour. Guidelines on oral intake in labour may be beneficial to women, balancing the preferences of women with risks of surgical intervention.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Wiley
Date: 24-02-2011
Publisher: Elsevier BV
Date: 04-2010
DOI: 10.1016/J.SINY.2009.09.003
Abstract: Maternal obesity is an important aspect of reproductive care. It is the commonest risk factor for maternal mortality in developed countries and is also associated with a wide spectrum of adverse pregnancy outcomes. Maternal obesity may have longer-term implications for the health of the mother and infant, which in turn will have economic implications. Efforts to prevent, manage and treat obesity in pregnancy will be costly, but may pay idends from reduced future economic costs, and subsequent improvements to maternal and infant health. Decision-makers working in this area of health services should understand whether the problem can be reduced, at what cost and then, what cost savings and health benefits will accrue in the future from a reduction of the problem.
Publisher: Wiley
Date: 13-12-2019
DOI: 10.1111/MCN.12750
No related grants have been discovered for Susan de Jersey.