ORCID Profile
0000-0003-0232-5848
Current Organisations
Bond University
,
University of Queensland
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 21-12-2020
DOI: 10.1097/GME.0000000000001684
Abstract: Weight loss may be difficult for young women with obesity to achieve due to competing priorities (caring for children and/or full-time work), limiting their ability to engage in weight loss interventions. Older or postmenopausal women may also face challenges to weight loss such as caring responsibilities and menopause. Menopausal status may reflect differences in weight loss. This study compared changes in weight, fat mass, and lean mass in premenopausal versus postmenopausal women in dietary weight loss trials. We reviewed publications from January 2000 to June 2020 evaluating a weight loss intervention with a dietary component, with or without exercise, and reporting weight loss of premenopausal and postmenopausal women. Where available, data on mean change from baseline for weight, fat mass, and lean mass of premenopausal and postmenopausal groups were entered into Review Manger for meta-analyses. Differences between menopausal groups were compared in subgroups of studies for intervention characteristics (diet-only vs diet and exercise dietary modification vs meal replacement 24 wks vs ≥24 wks duration). Seven publications (10 interventions, n = 791) were included three single-arm trials, two randomized controlled trials, and two comparative effectiveness trials. In meta-analyses, there were no statistically significant differences between premenopausal and postmenopausal women (shown as premenopausal minus postmenopausal) for change in weight (0.58 [95% confidence interval −0.12 to 1.28] kg, n = 7 interventions), fat mass (0.73 [−0.25 to 1.70] kg, n = 6 interventions), or lean mass (−0.5 6[−1.48 to 0.36] kg, n = 4 interventions). However, a statistically significant subgroup difference was observed for fat mass change between menopausal groups (premenopausal minus postmenopausal) when comparing diet-only (1.28 [0.23 to 2.33] kg, n = 4 interventions) versus diet and exercise interventions (−0.09 [−0.51 to 0.32]kg, n = 2 interventions). No differences were shown in any other subgroups. This review provides some evidence to suggest weight loss interventions may not need to be tailored to women's menopausal status. However, given the small number of studies, short intervention duration in most publications (≤ 6 mo) and unclear retention rates in premenopausal versus postmenopausal groups of some publications, menopausal group differences should be examined in existing and future trials where the appropriate data have been collected.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2003
DOI: 10.1097/00126334-200312150-00001
Abstract: Defective function of monocyte-derived macrophages contributes to HIV-1 pathogenesis. We found that phagocytosis of the opportunistic pathogens Mycobacterium avium complex and Toxoplasma gondii was impaired in monocytes obtained from in iduals infected with wild-type strains of HIV-1 but generally not in monocytes collected over a 6-year period from Sydney Blood Bank Cohort (SBBC) members infected with nef/long terminal repeats (LTR) region-defective strains of HIV-1. However, longitudinal analysis of phagocytosis in 1 SBBC member, C54, showed the development of defective engulfment of opportunistic pathogens at the most recent time points, coincident with the development of further molecular deletions in the nef/LTR region. Another SBBC member, C98, underwent bronchoscopy, which provided material to examine phagocytic signaling in alveolar macrophages. In contrast to normal phagocytic efficiency of C98's monocytes (over a 6-year period), defective signaling events during FcgammaR-mediated phagocytosis by C98's alveolar macrophages were observed. High basal phosphorylation within HIV-infected macrophages correlated with colocalization of tyrosine-phosphorylated proteins with HIV-1 p24 antigen rather than around the phagocytic targets as observed in uninfected cells. Thus, although phagocytic efficiency appears to be generally unimpaired in monocytes from SBBC members, evidence of impairment in recent s les from 1 SBBC member, coincident with further genetic changes within the virus, and abnormal phagocytic signaling in alveolar macrophages from another SBBC member may herald loss of attenuation of those strains.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2001
DOI: 10.1097/00002030-200105250-00002
Abstract: HIV-1 infection impairs a number of macrophage effector functions, but the mechanism is unknown. We studied the role of HIV-1 Nef in modulating phagocytosis by human monocytes and monocyte-derived macrophages (MDM). Using a flow cytometric assay, phagocytosis of Mycobacterium avium complex (MAC) by monocytes in whole blood of Sydney Blood Bank Cohort (SBBC) members infected with a nef-deleted (Delta nef) strain of HIV-1 was compared with that of monocytes from uninfected or wild-type (WT) HIV-infected subjects. The specific impact of Nef on phagocytosis by MDM was determined by either infecting cells in vitro with Delta nef strains of HIV-1 or electroporating Nef into uninfected MDM. MAC phagocytic capacity of monocytes from SBBC members was equivalent to that of cells from uninfected in iduals (P = 0.81) it was greater than that of cells from in iduals infected with WT HIV-1 (P < 0.0001), irrespective of CD4 counts and HIV viral load. In contrast, in vitro infection of MDM with either Delta nef or WT strains of HIV-1 resulted in similar levels of HIV replication and equivalent impairment of phagocytosis via Fc gamma and complement receptors. Electroporation of Nef into MDM did not alter phagocytic capacity. This study provides evidence demonstrating the complex indirect effect of Nef on phagocytosis by peripheral blood monocytes (infrequently infected with HIV-1) in vivo. Conversely, the fact that MDM infected with either Delta nef or WT HIV-1 in vitro (high multiplicity of infection) show comparably impaired phagocytosis, indicates that HIV-1 infection of macrophages can directly impair function, independent of Nef.
Publisher: Wiley
Date: 02-2022
Abstract: This systematic review aimed to describe behaviour change theories and techniques used to inform nutrition interventions for adults undergoing bariatric surgery. A systematic search was conducted across PubMed, PsycInfo, CENTRAL, EMBASE and CINAHL from inception until 09 March 2021. Eligible studies were randomised controlled trials involving nutrition interventions performed by a healthcare provider, to adults that were waitlisted or had undergone bariatric surgery and received a nutrition intervention explicitly informed by one or more behaviour change theories or behaviour change techniques. Screening was conducted independently by two authors. Behaviour change techniques were examined using the behaviour change technique taxonomy version one which includes 93 hierarchical techniques clustered into 16 groups. Quality of included studies was assessed using Cochrane risk of bias 2.0. Twenty‐one publications were included, involving 15 studies and 14 interventions, with 1495 participants. Bias was low or had some concerns. Two interventions reported using behaviour change theories (transtheoretical model and self‐determination theory). Thirteen behaviour change technique taxonomy groupings and 29 techniques were reported across 14 interventions. Common techniques included ‘1.2 Problem solving’ ( n = 9 studies), ‘3.1 Social support (unspecified)’ ( n = 9 studies), ‘1.1 Goal setting (behaviour)’ ( n = 6 studies) and ‘2.3 Self‐monitoring of behaviour’ ( n =‐ 6 studies). While behaviour change techniques have been included, behaviour change theory is not consistently reported and/or adopted to inform nutrition interventions for adults undergoing bariatric surgery. Integrating behaviour change theory and techniques in nutrition interventions is important for researchers and bariatric surgery teams, including dietitians, to effectively target behaviours for this population.
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.CLNU.2017.09.022
Abstract: Malnutrition is a significant barrier to healthy and independent ageing in older adults who live in their own homes, and accurate diagnosis is a key step in managing the condition. However, there has not been sufficient systematic review or pooling of existing data regarding malnutrition diagnosis in the geriatric community setting. The current paper was conducted as part of the MACRo (Malnutrition in the Ageing Community Review) Study and seeks to determine the criterion (concurrent and predictive) validity and reliability of nutrition assessment tools in making a diagnosis of protein-energy malnutrition in the general older adult community. A systematic literature review was undertaken using six electronic databases in September 2016. Studies in any language were included which measured malnutrition via a nutrition assessment tool in adults ≥65 years living in their own homes. Data relating to the predictive validity of tools were analysed via meta-analyses. GRADE was used to evaluate the body of evidence. There were 6412 records identified, of which 104 potentially eligible records were screened via full text. Eight papers were included two which evaluated the concurrent validity of the Mini Nutritional Assessment (MNA) and Subjective Global Assessment (SGA) and six which evaluated the predictive validity of the MNA. The quality of the body of evidence for the concurrent validity of both the MNA and SGA was very low. The quality of the body of evidence for the predictive validity of the MNA in detecting risk of death was moderate (RR: 1.92 [95% CI: 1.55-2.39] P < 0.00001 n = 2013 participants n = 4 studies I Due to the small number of studies identified and no evaluation of the predictive validity of tools other than the MNA, there is insufficient evidence to recommend a particular nutrition assessment tool for diagnosing PEM in older adults in the community. High quality diagnostic accuracy studies are needed for all nutrition assessment tools used in older community s les, including measuring of health outcomes subsequent to nutrition assessment by the SGA and PG-SGA.
Publisher: SAGE Publications
Date: 08-11-2022
DOI: 10.1177/1357633X221119620
Abstract: Digital health interventions can be useful for the management of chronic disease. The aim of this study was to draw out universal themes to understand how people with chronic conditions experience digital health services, programmes, and interventions, and consequently, better inform future digital health delivery. An umbrella review was conducted to identify qualitative systematic reviews reporting digital health experiences in chronic disease. Themes for each included review were independently extracted and appraised by two review authors. Data analysis was conducted using the Constant Comparative method. Twenty-two systematic reviews containing 240 in idual studies were selected for inclusion. Mental health was the most common condition ( n = 5, 23%), followed by cancer ( n = 4, 18%) or a combination of chronic diseases ( n = 4, 18%). Common themes across the conditions were categorised under nine headings, including: (i) participation and engagement (strong usability and engagement vs reluctance to use digital health when these concepts are ignored), (ii) trust, confidence, and competence (users felt reassured, however technology illiteracy led to a perceived lack of control), (iii) perceived value, perceived effectiveness, transaction cost (gained from efficient aspects of digital health, but also lost through the burden of keeping up with data entry), (iv) perceived care quality (requiring tailoring and fostering motivation), (v) barriers and threats (related to technology risks and challenges), (vi) health outcomes (improved self-management capability), (vii) relationships (improved participant-health professional interaction, but interpersonal aspects such as face-to-face contact were lacking), (viii) unplanned benefit (where digital health often led to users feeling more empowered in their health journey), and (ix) ersity of experiences (reflecting ambivalence of experiences and discipline-specific experiences). People with chronic conditions perceive digital health provides feelings of reassurance and the ability to self-manage their condition. While there is ambivalence across the participant experiences reported within the major themes, this umbrella review has outlined a need for future interventions that are user-friendly, flexible, and tailored to in idual users. This will be best achieved through a co-design model, with the consumer actively involved in the planning and design of digital health products and services.
Publisher: Wiley
Date: 08-2019
Publisher: Wiley
Date: 15-07-2019
Abstract: The present study aimed to systematically map and summarise existing research regarding dietetics workforce preparation and preparedness that has been conducted in Australia. The secondary aim was to then identify gaps in the literature to inform future priority areas in Australian dietetics education research. The databases MEDLINE, CINAHL, Embase, ERIC, Informit and PsycINFO were systematically searched from inception until July 2017 using key search terms to identify eligible studies. Extracted data were independently reviewed, and study quality was appraised by multiple researchers. Results were categorised by setting and primary focus/foci and then narratively summarised. Sixty-eight studies were included from 3779 records identified. Dietetics education research in Australia has spanned almost 30 years with more than half of studies (51% 35/68) published in the last five years. The greatest proportion of research was conducted in the university setting (43% 29/68), with students as participants (48% 43/90) and was focused on the medical nutrition therapy area of dietetics practice (43% 29/68). Published studies involving graduates (14% 13/90) conducted in the workplace (12% 8/68) and regarding emerging areas of dietetics practice (0% 0/90) are lacking. Employment outcomes of dietetics graduates across Australia were last published over 25 years ago. This review provides a map for dietetics educators and researchers in Australia to guide future research regarding the preparation and preparedness of dietitians. Advancing the Australian dietetics workforce of the future will require a strategic, coordinated and collaborative approach to address the research gaps identified in this review.
Publisher: JMIR Publications Inc.
Date: 28-07-2022
DOI: 10.2196/37556
Abstract: The metabolic syndrome is common across many complex chronic disease groups. Advances in health technology have provided opportunities to support lifestyle interventions. The purpose of this study is to test the feasibility of a health technology-assisted lifestyle intervention in a patient-led model of care. The study is a single-center, 26-week, randomized controlled trial. The setting is specialist kidney and liver disease clinics at a large Australian tertiary hospital. The participants will be adults with a complex chronic condition who are referred for dietetic assessment and display at least one feature of the metabolic syndrome. All participants will receive an in idualized assessment and advice on diet quality from a dietitian, a wearable activity monitor, and standard care. Participants randomized to the intervention group will receive access to a suite of health technologies from which to choose, including common base components (text messages) and optional components (online and mobile app–based nutrition information, an online home exercise program, and group-based videoconferencing). Exposure to the optional aspects of the intervention will be patient-led, with participants choosing their preferred level of engagement. The primary outcome will be the feasibility of delivering the program, determined by safety, recruitment rate, retention, exposure uptake, and telehealth adherence. Secondary outcomes will be clinical effectiveness, patient-led goal attainment, treatment fidelity, exposure demand, and participant perceptions. Primary outcome data will be assessed descriptively and secondary outcomes will be assessed using an analysis of covariance. This study will provide evidence on the feasibility of the intervention in a tertiary setting for patients with complex chronic disease exhibiting features of the metabolic syndrome. The study was funded in 2019. Enrollment has commenced and is expected to be completed by June 2022. Data collection and follow up are expected to be completed by December 2022. Results from the analyses based on primary outcomes are expected to be submitted for publication by June 2023. The study will test the implementation of a health technology–assisted lifestyle intervention in a tertiary outpatient setting for a erse group of patients with complex chronic conditions. It is novel in that it embeds patient choice into intervention exposure and will inform health service decision-makers in regards to the feasibility of scale and spread of technology-assisted access to care for a broader reach of specialist services. Australian New Zealand Clinical Trial Registry ACTRN12620001282976 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378337 DERR1-10.2196/37556
Publisher: SAGE Publications
Date: 22-06-2022
DOI: 10.1177/1357633X221107995
Abstract: Since the COVID-19 pandemic onset, there has been exponential growth in the uptake of telehealth, globally. However, evidence suggests that people living in lower socioeconomic areas, cultural and linguistically erse communities, people with disabilities, and with low health literacy are less likely to receive telehealth services. These population groups have disproportionately higher health needs and face additional barriers to healthcare access. Barriers that reduce access to telehealth further exacerbate existing gaps in care delivery. To improve equity of access to telehealth, we need to reduce the digital ide through a multi-stakeholder approach. This article proposes practical steps to reduce the digital ide and encourage equitable access to telehealth. Enabling more equitable access to telehealth requires improvements in digital health literacy, workforce training in clinical telehealth, co-design of new telehealth-enabled models of care, change management, advocacy for culturally appropriate services, and sustainable funding models.
Publisher: Elsevier BV
Date: 07-2017
Publisher: Wiley
Date: 10-2001
DOI: 10.1046/J.1440-1711.2001.01027.X
Abstract: The present study demonstrates that SRBC can be opsonized with untreated human serum such that lysis by active complement components is minimal but sufficient opsonization occurs to permit high rates of complement-mediated phagocytosis. Phagocytosis of SRBC opsonized with 2% whole human serum by human monocyte-derived macrophages was quantified in a colourimetric assay. Ingestion of SRBC was shown to occur solely via complement receptors because no phagocytosis was observed when SRBC were coated with heat- inactivated human serum, phagocytosis was augmented by the phorbol ester, PMA, and phagocytosis was inhibited by a protein kinase C (PKC)-specific inhibitor RO 31-8220. This method was used to demonstrate directly that HIV-1 infection of human monocyte-derived macrophages inhibits complement-mediated phagocytosis and will provide a useful tool for pharmacological investigations on complement-mediated phagocytosis by adherent macrophages.
Publisher: Informa UK Limited
Date: 12-05-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2000
DOI: 10.1097/00002030-200008180-00008
Abstract: Previous studies of the effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) on HIV-1 replication in macrophages have had inconsistent results, variously reporting no effect, augmentation or inhibition of viral replication. To investigate the regulation of HIV-1 in monocyte-derived macrophages (MDM) by GM-CSF in vitro. The role of GM-CSF on HIV-1 replication was assessed as supernatant and intracellular p24 antigen concentrations and by HIV-1 DNA and mRNA production under different culture conditions. Expression of CD4 and CCR5 receptors was examined. The effect of GM-CSF with an E21R mutation, which binds only to the alpha-chain of GM-CSF receptor, was used as an additional control. GM-CSF consistently suppressed HIV-1 replication in human MDM in vitro, as assessed by supernatant and intracellular p24 antigen concentrations and HIV-1 gag mRNA expression. The inhibitory effect of GM-CSF on HIV-1 replication was observed regardless of HIV-1 strain, source of GM-CSF, stage of MDM maturation or timing of GM-CSF exposure in relation to HIV-1 infection. The effect was dose dependent and reversed by addition of a neutralizing monoclonal antibody (4D4). Flow cytometric analysis of surface expression of CD4 and CCR5 indicates that GM-CSF does not affect HIV-1 entry into MDM. Analysis of intracellular HIV-1 DNA and mRNA suggests that HIV-1 replication is inhibited at or before transcription. E21R GM-CSF had no effect on HIV-1 replication in MDM. GM-CSF regulates HIV-1 replication in MDM, inhibiting HIV-1 replication through binding to the beta-chain of the GM-CSF receptor.
Publisher: Wiley
Date: 27-10-2020
DOI: 10.1111/JHN.12827
Abstract: Digital health is transforming the delivery of health care around the world to meet the growing challenges presented by ageing populations with multiple chronic conditions. Digital health technologies can support the delivery of personalised nutrition care through the standardised Nutrition Care Process (NCP) by using personal data and technology-supported delivery modalities. The digital disruption of traditional dietetic services is occurring worldwide, supporting responsive and high-quality nutrition care. These disruptive technologies include integrated electronic and personal health records, mobile apps, wearables, artificial intelligence and machine learning, conversation agents, chatbots, and social robots. Here, we outline how digital health is disrupting the traditional model of nutrition care delivery and outline the potential for dietitians to not only embrace digital disruption, but also take ownership in shaping it, aiming to enhance patient care. An overview is provided of digital health concepts and disruptive technologies according to the four steps in the NCP: nutrition assessment, diagnosis, intervention, and monitoring and evaluation. It is imperative that dietitians stay abreast of these technological developments and be the leaders of the disruption, not simply subject to it. By doing so, dietitians now, as well as in the future, will maximise their impact and continue to ch ion evidence-based nutrition practice.
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1093/AJCN/NQY041
Abstract: Dysfunction of the gut microbiota is frequently reported as a manifestation of chronic diseases, and therefore presents as a modifiable risk factor in their development. Diet is a major regulator of the gut microbiota, and certain types of dietary fiber may modify bacterial numbers and metabolism, including short-chain fatty acid (SCFA) generation. A systematic review and meta-analysis were undertaken to assess the effect of dietary fiber interventions on gut microbiota composition in healthy adults. A systematic search was conducted across MEDLINE, EMBASE, CENTRAL, and CINAHL for randomized controlled trials using culture and/or molecular microbiological techniques evaluating the effect of fiber intervention on gut microbiota composition in healthy adults. Meta-analyses via a random-effects model were performed on alpha ersity, prespecified bacterial abundances including Bifidobacterium and Lactobacillus spp., and fecal SCFA concentrations comparing dietary fiber interventions with placebo/low-fiber comparators. A total of 64 studies involving 2099 participants were included. Dietary fiber intervention resulted in higher abundance of Bifidobacterium spp. (standardized mean difference (SMD): 0.64 95% CI: 0.42, 0.86 P < 0.00001) and Lactobacillus spp. (SMD: 0.22 0.03, 0.41 P = 0.02) as well as fecal butyrate concentration (SMD: 0.24 0.00, 0.47 P = 0.05) compared with placebo/low-fiber comparators. Subgroup analysis revealed that fructans and galacto-oligosaccharides led to significantly greater abundance of both Bifidobacterium spp. and Lactobacillus spp. compared with comparators (P < 0.00001 and P = 0.002, respectively). No differences in effect were found between fiber intervention and comparators for α- ersity, abundances of other prespecified bacteria, or other SCFA concentrations. Dietary fiber intervention, particularly involving fructans and galacto-oligosaccharides, leads to higher fecal abundance of Bifidobacterium and Lactobacillus spp. but does not affect α- ersity. Further research is required to better understand the role of in idual fiber types on the growth of microbes and the overall gut microbial community. This review was registered at PROSPERO as CRD42016053101.
Publisher: Elsevier BV
Date: 07-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2016
Publisher: Wiley
Date: 08-07-2021
DOI: 10.1111/SDI.12998
Abstract: Digital health is increasingly recognized for its value to enhance patient care and clinical care processes. People with chronic kidney disease often find dietary self‐management challenging. There is promising evidence that digital health interventions can support people with chronic kidney disease to self‐manage their diet, by providing more frequent access to nutritional information and dietitians and by facilitating regular monitoring and feedback. There is some emerging evidence of the impact of digital interventions in chronic kidney disease however, more research is needed to provide meaningful interpretation of how digital interventions can enhance current practice. Importantly, a number of factors need to be considered when designing, developing, implementing, and evaluating the impact of digital interventions. Consideration of the nutrition service and patients' needs, motivation and digital literacy, type of digital intervention, and the ability to embed the digital intervention into current care processes are critical. This paper overviews the current literature on digital health and self‐management, factors to consider when embedding digital interventions and platforms into nutrition care and practical considerations for designing and implementing digital health interventions to enhance the nutritional care of people with chronic kidney disease.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Wiley
Date: 28-06-2020
Abstract: It is the position of Dietitians Australia that clients can receive high‐quality and effective dietetic services such as Medical Nutrition Therapy (MNT) delivered via telehealth. Outcomes of telehealth‐delivered dietetic consultations are comparable to those delivered in‐person, without requiring higher levels of additional training nor compromising quality of service provision. Dietitians Australia recommends that policy makers and healthcare funders broaden the recognition for telehealth‐delivered dietetic consultations as a responsive and cost‐effective alternative or complement to traditional in‐person delivery of dietetic services. The successful implementation of telehealth can help to address health and service inequalities, improve access to effective nutrition services, and support people with chronic disease to optimise their diet‐related health and well‐being, regardless of their location, income or literacy level, thereby addressing current inequities.
Publisher: Wiley
Date: 06-07-2023
DOI: 10.1002/OSP4.691
Abstract: Disordered eating, such as binge, graze, and emotional eating, has been strongly linked to weight gain. Improved understanding of disordered eating by adults who elect bariatric weight loss procedures in a real‐world setting is required. To determine the association between the number and type of disordered eating patterns (DEPs), as described by healthcare professionals during routine care without standardized assessment, with clinical outcomes in adults who elected a bariatric weight loss procedure. An observational cohort study recruited laparoscopic sleeve gastrectomy (LSG) and endoscopic sleeve gastroplasty (ESG) patients. DEPs documented in the medical record during routine care were observed and tested for association with events (symptoms, side‐effects, or adverse events), micronutrient deficiencies, weight loss, and attrition. Data were observed up to 12‐month post‐procedure. 215 LSG and 32 ESG patients were recruited. The mean number of DEPs was 6.4 (SD: 2.1) and 6.4 (SD: 2.1) in the LSG and ESG cohorts, respectively. Night eating was associated with a higher number of events ( p 0.008) in the LSG cohort, and non‐hungry eating was associated with a higher number of events in the ESG cohort ( p 0.001). ESG patients who had a surgical or medical event by 6‐months post‐procedure had mean 1.78 (95%CI: 0.67, 2.89) more DEPs ( p = 0.004). DEPs were not associated with weight loss, micronutrient deficiencies, nor attrition. The treating healthcare team believed the LSG and ESG patients experienced a wide variety and high frequency of DEPs requiring multidisciplinary support. Non‐hungry eating and night eating were associated with poorer outcomes following an LSG or ESG. The study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000332729).
Publisher: Wiley
Date: 24-04-2023
Abstract: This study aimed to explore patient barriers to accessing services, current technology ownership/use and digital device preferences for accessing health information/health service delivery. Additionally, it aimed to explore the Theoretical Domains Framework and the acceptability of future eHealth solutions in bariatric surgery. This mixed‐method study (survey and semi‐structured interviews) was conducted in a bariatric surgery service in an Australian public hospital. Quantitative data were analysed descriptively, and the qualitative data were deductively and inductively analysed. This study included 117 participants ( n = 102 surveyed and n = 15 interviewed). Most participants were aged ≥51 years ( n = 70, 60%), and two‐thirds were female ( n = 76, 65%). One in three participants reported barriers to accessing services ( n = 38, 37%), including parking, travel time, and taking time off work. Most participants preferred to receive or access additional health information via email ( n = 84, 82%) and were willing to engage with health professionals via email ( n = 92, 90%), text messages ( n = 87, 85%), and telephone ( n = 85, 83%). Deductive analysis of interviews generated three themes: ‘Knowledge’, ‘Social influence’ and ‘Behavioural regulation, goals and environmental resources’. The inductive analysis generated one theme: ‘Seeing a place for eHealth in service delivery’. This study's findings can potentially influence the development of future eHealth solutions. Text message, email, and online approaches may be suitable for delivering further information and resources to patients, particularly regarding diet and physical activity. Online health communities are being used by patients for social support and may be worth further investigation. In addition, developing a bariatric surgery mobile application may be beneficial.
Publisher: JMIR Publications Inc.
Date: 03-07-2023
Abstract: itizen Science is a community-based participatory research approach with an emphasis on addressing health disparities that is increasingly advocated by community, researchers and research funders. Digitally-enabled methods can extend the potential of Citizen Science by enabling citizens to engage in real-time research processes such as data collection, information sharing, interpreting, acting on data, and informing decision-making. However, the power of any Citizen Science lies in the equal opportunity for citizens to engage in the research process, key to promoting health equity. Without appropriate attention to recognising and addressing equity in Digitally-enabled Citizen Science, this approach in particular may extenuate rather than ameliorate health inequalities. In this viewpoint, we outline the practice of Citizen Science in the context of digital health - how it is operationalised, key advocated principles, and challenges. We discuss Citizen Science in relation to health equity and implementation science. We also operationalise Digitally-enabled Citizen Science and emphasise the importance of integrating health equity principles, frameworks, and health equity implementation determinants, and digital determinants of health. We demonstrate how equity could be achieved by providing a working ex le in the context of improving social, physical, and mental wellbeing among people with disability and carers.
Publisher: Oxford University Press (OUP)
Date: 07-09-2017
DOI: 10.1093/AJH/HPX123
Publisher: MDPI AG
Date: 15-12-2021
DOI: 10.3390/NU13124481
Abstract: Synbiotics have emerged as a therapeutic strategy for modulating the gut microbiome and targeting novel cardiovascular risk factors, including uremic toxins indoxyl sulfate (IS) and p-cresyl sulfate (PCS). This study aims to evaluate the feasibility of a trial of long-term synbiotic supplementation in adults with stage 3–4 chronic kidney disease (CKD). Adult participants with CKD and estimated glomerular filtration rate (eGFR) of 15–60 mL/min/1.73 m2) were recruited between April 2017 and August 2018 to a feasibility, double-blind, placebo-controlled, randomized trial of synbiotic therapy or matched identical placebo for 12 months. The primary outcomes were recruitment and retention rates as well as acceptability of the intervention. Secondary outcomes were treatment adherence and dietary intake. Exploratory outcomes were evaluation of the cardiovascular structure and function, serum IS and PCS, stool microbiota profile, kidney function, blood pressure, and lipid profile. Of 166 potentially eligible patients, 68 (41%) were recruited into the trial (synbiotic n = 35, placebo n = 33). Synbiotic and placebo groups had acceptable and comparable 12-month retention rates (80% versus 85%, respectively, p = 0.60). Synbiotic supplementation altered the stool microbiome with an enrichment of Bifidobacterium and Blautia spp., resulting in a 3.14 mL/min/1.73 m2 (95% confidence interval (CI), −6.23 to −0.06 mL/min/1.73 m2, p 0.01) reduction in eGFR and a 20.8 µmol/L (95% CI, 2.97 to 38.5 µmol/L, p 0.01) increase in serum creatinine concentration. No between-group differences were observed in any of the other secondary or exploratory outcomes. Long-term synbiotic supplementation was feasible and acceptable to patients with CKD, and it modified the gastrointestinal microbiome. However, the reduction in kidney function with synbiotics warrants further investigation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-12-2020
Abstract: Although CKD incidence is increasing, no evidence-based lifestyle recommendations for CKD primary prevention apparently exist. To evaluate evidence associating modifiable lifestyle factors and incidence of CKD, the authors undertook a systematic review and meta-analysis. Their analysis, which included 104 observational studies of 2,755,719 participants, demonstrated consistency of evidence for a number of measures associated with preventing CKD onset, including increasing dietary intake of vegetables and potassium (21% reduced odds and 22% reduced odds, respectively), increasing physical activity levels (18% reduced odds), moderating alcohol consumption (15% reduced risk), lowering sodium intake (21% increased odds), and stopping tobacco smoking (18% increased risk). In the absence of clinical trial evidence, these findings can help inform public health recommendations and patient-centered discussions in clinical practice about lifestyle measures to prevent CKD. Despite increasing incidence of CKD, no evidence-based lifestyle recommendations for CKD primary prevention apparently exist. To evaluate the consistency of evidence associating modifiable lifestyle factors and CKD incidence, we searched MEDLINE, Embase, CINAHL, and references from eligible studies from database inception through June 2019. We included cohort studies of adults without CKD at baseline that reported lifestyle exposures (diet, physical activity, alcohol consumption, and tobacco smoking). The primary outcome was incident CKD (eGFR ml/min per 1.73 m 2 ). Secondary outcomes included other CKD surrogate measures (RRT, GFR decline, and albuminuria). We identified 104 studies of 2,755,719 participants with generally a low risk of bias. Higher dietary potassium intake associated with significantly decreased odds of CKD (odds ratio [OR], 0.78 95% confidence interval [95% CI], 0.65 to 0.94), as did higher vegetable intake (OR, 0.79 95% CI, 0.70 to 0.90) higher salt intake associated with significantly increased odds of CKD (OR, 1.21 95% CI, 1.06 to 1.38). Being physically active versus sedentary associated with lower odds of CKD (OR, 0.82 95% CI, 0.69 to 0.98). Current and former smokers had significantly increased odds of CKD compared with never smokers (OR, 1.18 95% CI, 1.10 to 1.27). Compared with no consumption, moderate consumption of alcohol associated with reduced risk of CKD (relative risk, 0.86 95% CI, 0.79 to 0.93). These associations were consistent, but evidence was predominantly of low to very low certainty. Results for secondary outcomes were consistent with the primary finding. These findings identify modifiable lifestyle factors that consistently predict the incidence of CKD in the community and may inform both public health recommendations and clinical practice.
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1053/J.JRN.2016.10.005
Abstract: Emerging evidence suggests that dietary patterns are associated with survival in people with chronic kidney disease (CKD). This study evaluated the relationship between dietary habits and renal-related clinical outcomes in an established CKD cohort. Prospective cohort study. Three outpatient nephrology clinics in Queensland, Australia. A total of 145 adult patients with Stage 3 or 4 CKD (estimated glomerular filtration rate 15-59 mL/minute/1.73 m Dietary intake was measured using 24-hour recall and the HeartWise Dietary Habits Questionnaire (DHQ), which evaluates 10 components of dietary patterns in relation to cooking habits and intake of food groups. The primary outcome was a composite end point of all-cause mortality, commencement of dialysis, and doubling of serum creatinine. Secondary outcome was all-cause mortality alone. Multivariate cox regression analyses calculated hazard ratios (HRs) for associations between DHQ domains and occurrence of composite outcome and adjusted for confounders, including comorbidities and renal function. Over a median follow-up of 36 months, 32% (n = 47) reached the composite end point, of which 21% died (n = 30). Increasing DHQ score was associated with a lower risk of the composite end point with increasing intake of fruits and vegetables (HR: 0.61 95% CI, 0.39-0.94) and limiting alcohol consumption (HR, 0.79 95% CI: 0.65-0.96). For the secondary outcome of all-cause mortality, there was a significant association with adequate intake of fruits and vegetables (HR: 0.35 95% CI, 0.15-0.83). Healthy dietary patterns consisting of adequate fruits and vegetables and limited alcohol consumption are associated with a delay in CKD progression and improved survival in patients with Stage 3 or 4 CKD.
Publisher: Oxford University Press (OUP)
Date: 04-04-2023
Abstract: Telehealth-delivered nutrition interventions are effective in practice however, limited evidence exists regarding their cost-effectiveness. To evaluate the cost-effectiveness of telehealth-delivered nutrition interventions for improving health outcomes in adults with chronic disease. PubMed, CENTRAL, CINAHL, and Embase databases were systematically searched from database inception to November 2021. Included studies were randomized controlled trials delivering a telehealth-delivered diet intervention conducted with adults with a chronic disease and that reported on cost-effectiveness or cost-utility analysis outcomes. All studies were independently screened and extracted, and quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. All extracted data were grouped into subcategories according to their telehealth modality and payer perspective, and were analyzed narratively. Twelve randomized controlled trials comprising 5 phone-only interventions, 3 mobile health (mHealth), 2 online, and 1 each using a combination of phone–online or phone–mHealth interventions, were included in this review. mHealth interventions were the most cost-effective intervention in all studies. Across all telehealth interventions and cost analyses from health service perspectives, 60% of studies were cost-effective. From a societal perspective, however, 33% of studies reported that the interventions were cost-effective. Of the 10 studies using cost-utility analyses, 3 were cost saving and more effective, making the intervention dominant, 1 study reported no difference in costs or effectiveness, and the remaining 6 studies reported increased cost and effectiveness, meaning payers must decide whether this falls within an acceptable willingness-to-pay threshold for them. Quality of study reporting varied with between 63% to 92%, with an average of 77% of CHEERS items reported. Telehealth-delivered nutrition interventions in chronic disease populations appear to be cost-effective from a health perspective, and particularly mHealth modalities. These findings support telehealth-delivered nutrition care as a clinically beneficial, cost-effective intervention delivery modality.
Publisher: Oxford University Press (OUP)
Date: 27-03-2018
Abstract: The aim of this systematic review was to evaluate clinical trial data regarding the effect of resveratrol supplementation on cognitive performance and mood in populations that are healthy and in the clinical setting. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review of randomized controlled trials was conducted. A meta-analysis was also conducted to determine treatment effect on the following cognitive domains and mental processes: processing speed, number facility, memory, and mood. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool. Quality of the body of evidence was assessed by evidence for each outcome related to cognitive function for which data was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Ten studies were included. Three studies found resveratrol supplementation significantly improved some measures of cognitive performance, 2 reported mixed findings, and 5 found no effect. When data were pooled, resveratrol supplementation had a significant effect on delayed recognition (standardized mean difference [SMD], 0.39 95% confidence interval [CI], 0.08-0.70 I2 = 0% P = 0.01 n = 3 studies n = 166 participants) and negative mood (SMD, -0.18 95%CI, -0.31 to -0.05 I2 = 0% P = 0.006 n = 3 studies n = 163 participants). Included studies generally had low risk of bias and were of moderate or high quality. The results of this review indicate that resveratrol supplementation might improve select measures of cognitive performance however, the current literature is inconsistent and limited.
Publisher: Wiley
Date: 09-2016
DOI: 10.1111/NEP.12888
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.JAND.2022.01.012
Abstract: Practice guidelines for coronary heart disease and type 2 diabetes recommend promoting the Mediterranean dietary pattern (MDP), which improves cardiometabolic risk markers and may prevent disease progression and complications. It is unknown to what extent the MDP is recommended in routine care for patients with these conditions, particularly in multiethnic settings. The study aim was to explore multidisciplinary health care professionals' perspectives on recommending the MDP in routine care for patients with coronary heart disease or type 2 diabetes and barriers and enablers to its implementation. A qualitative description design was employed, utilizing semistructured in idual interviews to collect data. Fifty-seven clinicians (21 nurses, 19 doctors, 13 dietitians, and 4 physiotherapists) routinely managing relevant patients across hospital and community settings in a metropolitan health service in Australia participated in interviews between November 2019 and March 2020. Interviews were audiorecorded, transcribed verbatim, and analyzed using thematic analysis. Four overarching themes were identified highlighting that the MDP was not routinely recommended: current dietary practices (all clinicians perceived they had a role in dietary care but prioritization varied. There was a legacy of single nutrient-based strategies and disease silos) clinician-centered barriers to recommending MDP (limited MDP knowledge and practice skills and variable understanding and acceptance of evidence supporting its use. This was related to lack of education and training about the diet and personal interest/experience) organizational culture and resources influence dietary care (MDP not embedded in service culture or current clinic tools and resources, with limited dietary knowledge exchange within and across multidisciplinary teams) and perceived patient-centered barriers to implementation of MDP (socioeconomic challenges in a multicultural setting, and a lack of belief in patient capabilities to improve diet adherence). Clinician and organizational factors, compounded by perceptions about patient acceptance, influence recommendations of the MDP for patients with coronary heart disease or type 2 diabetes. These factors should be addressed to improve translation of MDP evidence into practice.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Springer Science and Business Media LLC
Date: 02-02-2018
Publisher: Informa UK Limited
Date: 23-03-2022
Publisher: SAGE Publications
Date: 02-02-2022
DOI: 10.1177/1357633X211070721
Abstract: Telehealth is a promising tool for delivering lifestyle interventions for the management of health conditions. However, limited evidence exists regarding the cost-effectiveness of these interventions. This systematic review aimed to evaluate the current literature reporting on the cost-effectiveness of telehealth-delivered diet and/or exercise interventions. Four electronic databases (PubMed, CENTRAL, CINAHL and Embase) were searched for published literature from database inception to November 2020. This review adhered to the preferred reporting items for systematic reviews and meta-analyses guidelines and the ISPOR Criteria for Cost-Effectiveness Review Outcomes Checklist. The quality of reporting was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. The extracted data were grouped into subcategories according to telehealth modality, organised into tables and reported narratively. Twenty-four studies of controlled trials (11 combined diet and exercise, 9 exercise-only and 4 diet-only telehealth-delivered interventions) were included for data extraction and quality assessment. Interventions were reported as cost-effective in 12 studies (50%), five studies (21%) reported inconclusive results, and seven studies (29%) reported that the interventions were not cost-effective. Telephone interventions were applied in eight studies (33%), seven studies (29%) used internet interventions, six studies (25%) used a combination of internet and telephone interventions, and three studies (13%) evaluated mHealth interventions. Quality of study reporting varied with between 54% and 92% of Consolidated Health Economic Evaluation Reporting Standards items reported. This review suggests that telehealth-delivered lifestyle interventions can be cost-effective compared to traditional care. There is a need for further investigations that employ rigorous methodology and economic reporting, including appropriate decision analytical models and longer timeframes.
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.JHIN.2011.06.009
Abstract: This study assessed the efficacy of a 'dry' hydrogen peroxide vapour decontamination in an Australian hospital via a two-armed study. The in vivo arm examined the baseline bacterial counts in high-touch zones within wards and evaluated the efficacy of cleaning with a neutral detergent followed by either hydrogen peroxide vapour decontamination, or a manual terminal clean with bleach or Det-Sol 500. The in vitro arm examined the efficacy of hydrogen peroxide vapour decontamination on a variety of different surfaces commonly found in the wards of an Australian hospital, deliberately seeded with a known concentration of vancomycin-resistant enterococci (VRE). All bacterial counts were evaluated by a protocol of contact plate method. In the in vivo arm, 33.3% of the high-touch areas assessed had aerobic bacterial count below the detection limit (i.e. no bacteria recoverable) post hydrogen peroxide decontamination, and in all circumstances the highest microbial density was ≤3 cfu/cm(2), while in the in vitro arm there was at least a reduction in bacterial load by a factor of 10 at all surfaces investigated. These results showed that dry hydrogen peroxide vapour room decontamination is highly effective on a range of surfaces, although the cleanliness data obtained by these methods cannot be easily compared among the different surfaces as recovery of organisms is affected by the nature of the surface.
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.JAND.2019.01.023
Abstract: Dietary behavior change interventions for the self-management of chronic kidney disease (CKD) have the potential to slow disease progression and reduce metabolic complications. Telehealth-delivered dietary interventions may assist in the self-management of CKD, although their acceptability by patients is unknown. This study aims to describe the acceptability and experiences of a telehealth coaching intervention that utilized telephone calls and tailored text messages to improve diet quality in patients with stage 3 to 4 CKD. Semistructured interview study of adults with CKD. Adults with stage 3 to 4 CKD (n=21) aged 28 to 78 (mean 62) years, who completed a 12-week telehealth-delivered dietary intervention in Queensland, Australia, were interviewed from March to July 2017. Interviews were transcribed verbatim and analyzed thematically. Five themes were identified: valuing relationships (receiving tangible and perceptible support, building trust and rapport remotely, motivated by accountability, readily responding to a personalized approach, reassured by health professional expertise) appreciating convenience (integrating easily into lifestyle, talking comfortably in a familiar environment, minimizing travel and wait time burden) empowered with actionable knowledge (comprehending diet-disease mechanisms, practical problem solving for sustainable dietary behavior) increasing diet consciousness (learning from recurrent feedback, prompted by reiteration of messages) making sense of complexity (contextualizing and prioritizing comorbidities, gaining confidence to make dietary decisions, setting and achieving realistic goals). Among adults with stage 3 to 4 CKD, in idualized telehealth coaching for improving diet quality was convenient for patients, and they felt supported and empowered to navigate recommendations and prioritize dietary behavior changes. Telehealth-delivered dietary interventions appear to be well accepted by patients as a way of providing regular, tailored contact with a health professional to support dietary management in CKD.
Publisher: Wiley
Date: 20-03-2017
DOI: 10.1111/DME.13340
Abstract: Patient education for the management of Type 2 diabetes can be delivered in various forms, with the goal of promoting and supporting positive self-management behaviours. This systematic review aimed to determine the effectiveness of group-based interventions compared with in idual interventions or usual care for improving clinical, lifestyle and psychosocial outcomes in people with Type 2 diabetes. Six electronic databases were searched. Group-based education programmes for adults with Type 2 diabetes that measured glycated haemoglobin (HbA Fifty-three publications describing 47 studies were included (n = 8533 participants). Greater reductions in HbA Group-based education interventions are more effective than usual care, waiting list control and in idual education at improving clinical, lifestyle and psychosocial outcomes in people with Type 2 diabetes.
Publisher: Elsevier BV
Date: 12-2016
Abstract: The long-term management of chronic disease requires the adoption of complex dietary recommendations, which can be facilitated by regular coaching to support behavioral changes. Telehealth interventions can overcome patient-centered barriers to accessing face-to-face programs and provide feasible delivery methods, accessible regardless of geographic location. This systematic review assessed the effectiveness of telehealth dietary interventions at facilitating dietary change in chronic disease. A structured systematic search was conducted for all randomized controlled trials evaluating multifactorial dietary interventions in adults with chronic disease that provided diet education in an intervention longer than 4 wk. Meta-analyses that used the random-effects model were performed on diet quality, dietary adherence, fruit and vegetables, sodium intake, energy, and dietary fat intake. A total of 25 studies were included, involving 7384 participants. The telehealth dietary intervention was effective at improving diet quality [standardized mean difference (SMD): 0.22 (95% CI: 0.09, 0.34), P = 0.0007], fruit and vegetable intake [mean difference (MD) 1.04 servings/d (95% CI: 0.46, 1.62 servings/d), P = 0.0004], and dietary sodium intake [SMD: -0.39 (-0.58, -0.20), P = 0.0001]. Single nutrients (total fat and energy consumption) were not improved by telehealth intervention however, after a telehealth intervention, important clinical outcomes were improved, such as systolic blood pressure [MD: -2.97 mm Hg (95% CI: -5.72, -0.22 mm Hg), P = 0.05], total cholesterol [MD: -0.08 mmol/L (95% CI: -0.16, -0.00 mmol/L), P = 0.04], triglycerides [MD: -0.10 mmol/L (95% CI: -0.19, -0.01 mmol/L), P = 0.04], weight [MD: -0.80 kg (95% CI: -1.61, 0 kg), P = 0.05], and waist circumference [MD: -2.08 cm (95% CI: -3.97, -0.20 cm), P = 0.03]. Telehealth-delivered dietary interventions targeting whole foods and/or dietary patterns can improve diet quality, fruit and vegetable intake, and dietary sodium intake. When applicable, they should be incorporated into health care services for people with chronic conditions. This review was registered at www.crd.york.ac.uk/PROSPERO/ as CRD42015026398.
Publisher: MDPI AG
Date: 17-08-2022
DOI: 10.3390/NU14163365
Abstract: Alterations in body composition, in particular sarcopenia and sarcopenic obesity, are complications of liver cirrhosis associated with adverse outcomes. This systematic review aimed to evaluate the effect of diet and/or exercise interventions on body composition (muscle or fat) in adults with cirrhosis. Five databases were searched from inception to November 2021. Controlled trials of diet and/or exercise reporting at least one body composition measure were included. Single-arm interventions were included if guideline-recommended measures were used (computed tomography/magnetic resonance imaging, dual-energy X-ray absorptiometry, bioelectrical impedance analysis, or ultrasound). A total of 22 controlled trials and 5 single-arm interventions were included. Study quality varied (moderate to high risk of bias), mainly due to lack of blinding. Generally, s le sizes were small (n = 6–120). Only one study targeted weight loss in an overweight population. When guideline-recommended measures of body composition were used, the largest improvements occurred with combined diet and exercise interventions. These mostly employed high protein diets with aerobic and or resistance exercises for at least 8 weeks. Benefits were also observed with supplementary branched-chain amino acids. While body composition in cirrhosis may improve with diet and exercise prescription, suitably powered RCTs of combined interventions, targeting overweight/obese populations, and using guideline-recommended body composition measures are needed to clarify if sarcopenia/sarcopenic obesity is modifiable in patients with cirrhosis.
Publisher: Wiley
Date: 11-12-2023
Abstract: This study explored clinicians' perspectives on roles, practices and service delivery in the dietary management of coronary heart disease and type 2 diabetes in a public health service. Semi‐structured in idual interviews were conducted with 57 clinicians (21 nurses, 19 doctors, 13 dietitians and 4 physiotherapists) involved in the care of relevant patients across hospital and post‐acute community settings in a metropolitan health service in Australia. Interviews were audio‐recorded, transcribed verbatim and analysed using inductive thematic analysis. A total of 3 themes with 10 subthemes were identified. (a) ‘Treatment prioritisation’: important role of nutrition in risk factor management competing priorities with complex patients weight loss as a priority and dietitians in idualise. (b) ‘Diverse roles in providing diet advice’: a tension between nutrients, restrictions and diet quality patients seek and trust advice from non‐dietitians and providing nutrition information materials crosses professions. (c) ‘Dietitian access’: variable integration and resourcing access governed by clinician discretion and perceived patient interest and bespoke application of referral pathways. Time and resource constraints, variable access and referral to dietitians, and inconsistent advice were key challenges in the dietary management of coronary heart disease and type 2 diabetes. Models of care may be improved with greater investment and integration of dietitians, including to provide professional support across disciplines and disease specialties.
Publisher: Wiley
Date: 05-2018
Publisher: Wiley
Date: 13-05-2019
Abstract: Interventions to prevent excessive weight gain after liver transplant are needed. The purpose of the present study was to enhance a specialist post-transplant well-being program through knowledge exchange with end-users. The study used an interactive process of knowledge exchange between researchers, clinicians and health system users. Data were collected as focus groups or telephone interviews and underwent applied thematic analysis. There were 28 participants (age 24-68 years 64% male). The results identified experiences that may influence decisions around health behaviours during the course of transplant recovery. Three over-arching themes were identified that impact on liver transplant recipients post-transplant health behaviours. These include (i) Finding a coping mechanism which highlighted the need to acknowledge the significant emotional burden of transplant prior to addressing long-term physical wellness (ii) Back to Life encompassing the desire to return to employment and prioritise family, while co-ordinating the burden of ongoing medical monitoring and self-management and (iii) Tailored, Personalised Care with a preference for health care delivery by transplant specialists via a range of flexible eHealth modalities. This person-centred process of knowledge exchange incorporated experiences of recipients into service design and identified life priorities most likely to influence health behaviours post-transplant. Patient co-creation of services has the potential to improve the integration of knowledge into health systems and future directions will require evaluation of effectiveness and sustainability of patient-centred multidisciplinary service development.
Publisher: Wiley
Date: 07-11-2019
DOI: 10.1111/DME.14158
Abstract: To assess the completeness of reporting of group-based education interventions for the management of type 2 diabetes. A previous systematic review of group-based education programmes for adults with type 2 diabetes identified eligible intervention studies. Data were extracted and assessed using the Template for Intervention Description and Replication ('TIDieR') checklist. Missing data were sourced from other published material, or by contacting authors. Fifty-three publications describing 47 studies were included. No publications sufficiently described all items. Authors of 43 of the 47 included studies (91%) were contacted via e-mail to obtain missing data in order to complete the TIDieR checklist. Seven (16%) did not respond. Additional data were obtained for 33/47 studies (70%). Most studies (45/47, 96%) described the intervention duration and frequency, detailed the procedures and rationale (40/47, 85%), provided a brief intervention name and explained any in idual tailoring (38/47, 81%), defined whether providers received training and adequately described how the programme was delivered (37/47, 79%). However, few described any modifications (28/47, 60%), whether the intervention was delivered as planned (27/47, 57%), where it was delivered (21/47, 45%), whether materials were provided (19/47, 40%), and who delivered the intervention (13/47, 28%). Group-based education interventions for the management of type 2 diabetes are poorly reported. To translate effective research into practice, practitioners need sufficient detail to implement evidence-based interventions. Researcher adoption of the TIDieR checklist will assist the translation and replication of published interventions.
Publisher: BMJ
Date: 2019
DOI: 10.1136/BMJOPEN-2018-024551
Abstract: To evaluate the feasibility and acceptability of a personalised telehealth intervention to support dietary self-management in adults with stage 3–4 chronic kidney disease (CKD). Mixed-methods process evaluation embedded in a randomised controlled trial. People with stage 3–4 CKD (estimated glomerular filtration rate [eGFR]15–60 mL/min/1.73 m 2 ). Participants were recruited from three hospitals in Australia and completed the intervention in ambulatory community settings. The intervention group received one telephone call per fortnight and 2–8 tailored text messages for 3 months, and then 4–12 tailored text messages for 3 months without telephone calls. The control group received usual care for 3 months then non-tailored education-only text messages for 3 months. Feasibility (recruitment, non-participation and retention rates, intervention fidelity and participant adherence) and acceptability (questionnaire and semistructured interviews). Descriptive statistics and qualitative content analysis. Overall, 80/230 (35%) eligible patients who were approached consented to participate (mean±SD age 61.5±12.6 years). Retention was 93% and 98% in the intervention and control groups, respectively, and 96% of all planned intervention calls were completed. All participants in the intervention arm identified the tailored text messages as useful in supporting dietary self-management. In the control group, 27 (69%) reported the non-tailored text messages were useful in supporting change. Intervention group participants reported that the telehealth programme delivery methods were practical and able to be integrated into their lifestyle. Participants viewed the intervention as an acceptable, personalised alternative to face-face clinic consultations, and were satisfied with the frequency of contact. This telehealth-delivered dietary coaching programme is an acceptable intervention which appears feasible for supporting dietary self-management in stage 3–4 CKD. A larger-scale randomised controlled trial is needed to evaluate the efficacy of the coaching programme on clinical and patient-reported outcomes. ACTRN12616001212448 Results.
Publisher: Elsevier BV
Date: 12-2018
Publisher: Cambridge University Press (CUP)
Date: 26-03-2022
DOI: 10.1017/S0007114521001100
Abstract: Practice guidelines for non-alcoholic fatty liver disease (NAFLD) recommend promoting the Mediterranean dietary pattern (MDP) which is cardioprotective and may improve hepatic steatosis. This study aimed to explore multidisciplinary clinicians’ perspectives on whether the MDP is recommended in routine management of NAFLD and barriers and facilitators to its implementation in a multi-ethnic setting. Semi-structured in idual interviews were conducted with fourteen clinicians (seven doctors, three nurses, three dietitians and one exercise physiologist) routinely managing patients with NAFLD in metropolitan hospital outpatient clinics in Australia. Interviews were audio-recorded, transcribed and analysed using thematic content analysis. Clinicians described that lifestyle modification was their primary treatment for NAFLD and promoting diet was recognised as everyone’s role, whereby doctors and nurses raise awareness and dietitians provide in idualisation. The MDP was regarded as the most evidence-based diet choice currently and was frequently recommended in routine care. Facilitators to MDP implementation in practice were: improvement in diet quality as a parallel goal to weight loss in-depth knowledge of the dietary pattern access to patient education and monitoring resources and service culture, including an interdisciplinary clinic goal, and knowledge sharing from expert dietitians. Barriers included perceived challenges for patients from erse cultural and socio-economic backgrounds and limited clinician training, time and resourcing to support behaviour change. Integration of MDP in routine management of NAFLD in specialist clinics was facilitated by a focus on diet quality, knowledge sharing, belief in evidence and an interdisciplinary team. Innovations to service delivery could better support and empower patients to change dietary behaviour long-term.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1053/J.JRN.2017.07.008
Abstract: People with chronic kidney disease (CKD) contend with complex dietary recommendations. The challenge in practice is for clinicians to provide in idualized support with the frequency and consistency required to sustain dietary changes. This study aimed to describe the experiences of patients with managing dietary recommendations, including their perspectives on the potential to use telehealth to support dietary management in CKD. Focus group study. Twenty-one adult patients with CKD (nondialysis) and 3 caregivers (total N = 24) purposively s led to achieve erse demographic and clinical characteristics, from two nephrology units in Queensland, Australia. Five focus groups were conducted, audio recorded, and transcribed. Transcripts were analyzed using thematic analysis drawing on the principles of grounded theory. Themes aligned with the research question. We identified five themes: exasperating stagnancy (patronized by redundant advice, confused and unprepared for dietary change, inevitability of failure, and barriers to accessing dietetic services) supporting and sustaining change (receiving regular feedback, incremental and comprehendible modification, practical guidance on food, flexibility in monitoring schedule, and valuing peer advice) fostering ownership (seeking kidney diet information, enacting behavior change, making reminders, and tracking progress against targets) motivators and positive learning instruction (relying on reassurance, positive reinforcement, focusing on allowable foods, and involving family) threats and ambiguities of risk (sugar as the culprit, ubiquity of salt, illegible food labeling, avoiding processed foods, and questioning credibility of sources). Patients with CKD desire a preventative approach to CKD progression and maintaining their health, however, are stymied by dietary restrictions and a lack of reliable dietetic advice. Easy-to-use telehealth options have the potential to overcome the shortcomings in current health service delivery which may be limiting factors to providing these approaches. They provide patients with pragmatic tools, comprehensible and consistent information which fosters ownership and self-monitoring.
Publisher: Wiley
Date: 12-06-2022
Abstract: The aim of the study was to describe the quantity and cost of in‐person and telehealth dietetics services reimbursed under Australia's Medicare Benefits Scheme, before and during the coronavirus pandemic. Publicly available Medicare Benefits Scheme dietetics service activity data were extracted from an online database, between January 2019 and June 2021. For allied health telehealth items, it was assumed that between 10% and 20% of all consults were dietetic related. Dietetics service claims reimbursed through the Medicare Benefits Scheme averaged 115 thousand per quarter in 2019. In quarter 2 of 2020, service delivery dropped by 25% compared to quarter 1 of 2020 and 32% compared to 2019. This drop recovered in quarters 3 and 4, with dietetic consultations claimed through the Medicare Benefits Scheme remaining relatively comparable to 2019 data. Dietetics services cost AUD 5,868,021 in quarter 1 2019 and AUD 5,742,632 in quarter 1 2020. Since the introduction of allied health telehealth items, the number of consultations claimed per quarter has accounted for between 17.7% (quarter 2 2020) and 4.5% (quarter 2 2021) of all consultations per quarter. The provision and costs of dietetics services in Australia have remained relatively constant compared to 2019 data, indicating telehealth was being used for substitutive rather than additive care, apart from an initial reduction of 25% between March and June 2020. The introduction of telehealth items for dietitians has been modest, peaking at 17.7% and now consistently averaging 5% of total dietetics services. The permanent implementation of telehealth items is unlikely to cause significant increases in cost or access and will assist Australians to eat better to support improved chronic disease outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-09-2019
DOI: 10.2215/CJN.00530119
Abstract: Whether a healthy dietary pattern may prevent the incidence of developing CKD is unknown. This study evaluated the associations between dietary patterns and the incidence of CKD in adults and children. This systematic review and meta-analysis identified potential studies through a systematic search of MEDLINE, Embase and references from eligible studies from database inception to February 2019. Eligible studies were prospective and retrospective cohort studies including adults and children without CKD, where the primary exposure was dietary patterns. To be eligible, studies had to report on the primary outcome, incidence of CKD (eGFR ml/min per 1.73 m 2 ). Two authors independently extracted data, assessed risk of bias and evidence certainty using the Newcastle–Ottawa scale and GRADE. Eighteen prospective cohort studies involving 630,108 adults (no children) with a mean follow-up of 10.4±7.4 years were eligible for analysis. Included studies had an overall low risk of bias. The evidence certainty was moderate for CKD incidence and low for eGFR decline (percentage drop from baseline or reduced by at least 3 ml/min per 1.73 m 2 per year) and incident albuminuria. Healthy dietary patterns typically encouraged higher intakes of vegetables, fruit, legumes, nuts, whole grains, fish and low-fat dairy, and lower intakes of red and processed meats, sodium, and sugar-sweetened beverages. A healthy dietary pattern was associated with a lower incidence of CKD (odds ratio [OR] 0.70 (95% confidence interval [95% CI], 0.60 to 0.82) I 2 =51% eight studies), and incidence of albuminuria (OR 0.77, [95% CI, 0.59 to 0.99] I 2 =37%) four studies). There appeared to be no significant association between healthy dietary patterns and eGFR decline (OR 0.70 [95% CI, 0.49 to 1.01], I 2 =49% four studies). A healthy dietary pattern may prevent CKD and albuminuria.
Publisher: Wiley
Date: 05-2017
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/20552076221104670
Abstract: To determine the perspectives to the adoption, scale-up, sustainability, and spread of technology-supported models of nutrition care, in hospital and ambulatory care settings. Thirty-one health service providers participated in in idual semi-structured interviews from a tertiary health service in Queensland, Australia. The Non-adoption, Abandonment, and challenges to the Scale up, Spread and Sustainability (NASSS) framework, designed to evaluate technology-supported models’ success, informed the qualitative design. Key findings were that technology-supported models of care could benefit many chronic condition patient groups dietitians are well suited to adopting this technology: and the value proposition in creating efficiency gains in the health service. However, challenges of transitioning and sustainability were identified. Perceived enablers for technology supported models of care included: previous intentions for technology supported models of care prior to the 2019 novel coronavirus pandemic opportunity for clinicians to complete higher valued tasks and integration of technology systems and assisted staff roles. Perceived barriers included: suitability for patients is dependent on experience and ability to use technology, varied confidence by clinicians when conducting clinical assessments high investment required for set up and ongoing maintenance and patients desire for adopting face-to-face care over technology. Health service providers perceived that embedding and adapting such models requires maintenance of high-quality service and continued research. Health service providers recognize adopting, scaling, and sustaining technology-supported models of nutrition care benefits patients, clinicians, and health services in general. Robust clinical trials and health service evaluations of technology-supported models of care, across practice settings are now needed.
Publisher: Springer Science and Business Media LLC
Date: 09-10-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 28-02-2020
DOI: 10.2215/CJN.12341019
Abstract: The dietary self-management of CKD is challenging. Telehealth interventions may provide an effective delivery method to facilitate sustained dietary change. This pilot, randomized, controlled trial evaluated secondary and exploratory outcomes after a dietitian-led telehealth coaching intervention to improve diet quality in people with stage 3–4 CKD. The intervention group received phone calls every 2 weeks for 3 months (with concurrent, tailored text messages for 3 months), followed by 3 months of tailored text messages without telephone coaching, to encourage a diet consistent with CKD guidelines. The control group received usual care for 3 months, followed by nontailored, educational text messages for 3 months. Eighty participants (64% male), aged 62±12 years, were randomized to the intervention or control group. Telehealth coaching was safe, with no adverse events or changes to serum biochemistry at any time point. At 3 months, the telehealth intervention, compared with the control, had no detectable effect on overall diet quality on the Alternative Health Eating Index (3.2 points, 95% confidence interval, −1.3 to 7.7), nor at 6 months (0.5 points, 95% confidence interval, −4.6 to 5.5). There was no change in clinic BP at any time point in any group. There were significant improvements in several exploratory diet and clinical outcomes, including core food group consumption, vegetable servings, fiber intake, and body weight. Telehealth coaching was safe, but appeared to have no effect on the Alternative Healthy Eating Index or clinic BP. There were clinically significant changes in several exploratory diet and clinical outcomes, which require further investigation. Evaluation of In idualized Telehealth Intensive Coaching to Promote Healthy Eating and Lifestyle in CKD (ENTICE-CKD), ACTRN12616001212448.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.MATURITAS.2018.02.012
Abstract: Telehealth offers a feasible method to provide nutrition support to malnourished older adults. This systematic review and meta-analysis aims to determine the efficacy of telehealth methods in delivering malnutrition-related interventions to community-dwelling older adults. Studies in any language were searched in five electronic databases from inception to 2nd November 2017. Quality of the evidence was assessed using the Cochrane Risk of Bias tool and the GRADE approach. Nine studies were identified, with results published across 13 included publications, which had mostly low to unclear risk of bias. There were two interventions delivered to disease-specific groups, one with kidney disease and one with cancer the remaining seven interventions were delivered to patients with mixed morbidities following discharge from an inpatient facility. Seven studies delivered telehealth via telephone consultations and two used internet-enabled telemedicine devices. Ten meta-analyses were performed. Malnutrition-focused telehealth interventions were found to improve protein intake in older adults by 0.13 g/kg body weight per day ([95%CI: 0.01-0.25] P = .03 n = 2 studies n = 200 participants I
Publisher: SAGE Publications
Date: 17-03-2023
DOI: 10.1177/1357633X231160333
Abstract: To gain a better understanding of consumer experiences with and preferences for telephone and videoconference consultations (telehealth), and how these compare to traditional in-person consultations. A national cross-sectional survey was administered to a representative s le of Australian adults who have received a telehealth service within the last year. Consumers were recruited by Qualtrics® through their online s ling service. The s le was representative of the broader Australian population according to gender, age, location (state/territory), and place of residence (urban or remote). Information on demographics (e.g., age, gender, employment status), recent telehealth experience, and preferences for consultation modality was collected. To measure preferences consumers were asked to indicate which modality they would prefer (in-person, telephone, or videoconference) for different scenarios. These included consultations of various time lengths, and for the top ten conditions for which in iduals sought a general practitioner. A total of 1069 consumers completed the survey. When consumers were asked to describe their most recent telehealth appointment, most were for follow-up appointments (67%) and completed by telephone (77%) rather than by videoconference, and with a general practitioner (75%). In-person consultations at a clinic were the top preference in all clinical scenarios presented, except when needing a prescription or to receive test results. In these cases, a telephone consultation was the preferred modality. Inexperience with videoconference and duration of consultation influenced preference for consultation mode. Consumers preferred to have short consultations of around five minutes done by telehealth (telephone or videoconference), while they preferred in-person for longer consultations (up to 60 minutes). Many Australians have used telehealth in the past year to access healthcare, with telephone being the most common form of communication. Given the option and the experience to date, consumers prefer telephone when consultations related to either prescriptions or test results. Experience with videoconference for consultations increased consumer preferences for using it for future consultations.
Publisher: JMIR Publications Inc.
Date: 11-12-2017
DOI: 10.2196/JMIR.8193
Publisher: Wiley
Date: 30-08-2018
DOI: 10.1111/NEP.13441
Publisher: CSIRO Publishing
Date: 24-11-2022
DOI: 10.1071/AH22220
Abstract: Objectives To describe the quantity and cost of in-person and telehealth exercise physiology (EP) reimbursed under the Medicare Benefits Schedule (MBS) in Australia before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods This study uses publicly available MBS data to describe EP services (in-person and telehealth) reimbursed by Medicare between January 2020 and December 2021. Data were extracted at state and national levels. Results Despite a reduction in quantity and cost in quartile (Q) 2 2020 (41% reduction), MBS-reimbursed EP services have remained relatively constant at a national level through the 2-year observation period. Service claims averaged 88 555 per quarter in 2020 and 95 015 in 2021. The proportion of telehealth consultations relative to total quarterly claims for EP was % in Q1 2020, 6.0% in Q2 2020, 2.4% in Q3 2020 and 1.7% in Q4 2020. This dropped to an average of 1.4% across 2021 (Q1–Q4). States undergoing lockdown periods reported decreased service rates relative to February 2020 (i.e. pre-lockdown). EP services were associated with a Medicare expenditure of AUD17.9M in 2020 (telehealth = 2.4% of total) and AUD19.7M (telehealth = 1.5% of total) in 2021. Conclusions Quantity and cost of MBS-reimbursed EP services remained relatively constant throughout the height of service disruption due to COVID-19 (2020/21). Telehealth uptake during this time has been minimal for EP.
Publisher: MDPI AG
Date: 07-11-2017
DOI: 10.3390/NU9111224
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-12-2016
DOI: 10.2215/CJN.06190616
Abstract: Patients with CKD are advised to follow dietary recommendations that restrict in idual nutrients. Emerging evidence indicates overall eating patterns may better predict clinical outcomes, however, current data on dietary patterns in kidney disease are limited. This systematic review aimed to evaluate the association between dietary patterns and mortality or ESRD among adults with CKD. Medline, Embase, and reference lists were systematically searched up to November 24, 2015 by two independent review authors. Eligible studies were longitudinal cohort studies reporting the association of dietary patterns with mortality, cardiovascular events, or ESRD. A total of seven studies involving 15,285 participants were included. Healthy dietary patterns were generally higher in fruit and vegetables, fish, legumes, cereals, whole grains, and fiber, and lower in red meat, salt, and refined sugars. In six studies, healthy dietary patterns were consistently associated with lower mortality (3983 events adjusted relative risk, 0.73 95% confidence interval, 0.63 to 0.83 risk difference of 46 fewer (29–63 fewer) events per 1000 people over 5 years). There was no statistically significant association between healthy dietary patterns and risk of ESRD (1027 events adjusted relative risk, 1.04 95% confidence interval, 0.68 to 1.40). Healthy dietary patterns are associated with lower mortality in people with kidney disease. Interventions to support adherence to increased fruit and vegetable, fish, legume, whole grain, and fiber intake, and reduced red meat, sodium, and refined sugar intake could be effective tools to lower mortality in people with kidney disease.
Publisher: Wiley
Date: 26-02-2017
DOI: 10.1111/SDI.12580
Abstract: People with kidney disease are advised to restrict in idual nutrients, such as sodium, potassium, and phosphate, in line with current best practice guidelines. However, there is limited evidence to support the efficacy of single nutrient strategies, and compliance remains a challenge for clinicians to overcome. Many factors contribute to poor compliance with dietary prescriptions, including conflicting priorities for single nutrient restriction, the arduous self-monitoring required, and the health-related knock-on effects resulting from targeting these nutrients in isolation. This paper reviews the evidence base for the overall pattern of eating as a potential tool to deliver a diet intervention in which all the nutrients and foods work cumulatively and synergistically to improve clinical outcomes. These interventions may assist in kidney disease management and overcome these innate challenges that single nutrient interventions possess. Healthy dietary patterns are typically plant-based and lower in sodium and animal proteins. These patterns may have numerous mechanistic benefits for cardiovascular health in kidney disease, most notably through the increase in fruit, vegetables, and plant-based protein, as well as improved gut health through the increase in dietary fiber. The evidence to date on optimal dietary patterns points toward use of a predominantly plant-based diet, and suggests its adoption may improve clinical outcomes in dialysis patients. However, clinical trials are needed to determine whether these diet interventions are feasible, safe, and effective in this patient population.
Publisher: Elsevier BV
Date: 03-2023
Publisher: Wiley
Date: 16-01-2023
DOI: 10.1111/JHN.13125
Abstract: Digital health interventions may facilitate management of chronic conditions however, no reviews have systematically assessed the effectiveness of dietary interventions delivered by digital health platforms for improving dietary intake and clinical outcomes for adults with diet‐related chronic conditions. Databases CINAHL, CENTRAL, Embase and MEDLINE were searched from inception to April 2021 to identify controlled trials for dietary education delivered by digital health (mobile or electronic health) to adults with diet‐related chronic conditions. Random effects analysis was performed for diet quality, food groups, nutrients and clinical outcomes. Screening, data extraction and quality checking were completed in duplicate. Thirty‐nine studies were included involving 7333 participants. Significant changes were found for Mediterranean diet adherence score (standardised mean difference [SMD] = 0.79 95% confidence interval [CI] = 0.18 to 1.40), overall fruit and vegetable intake (mean difference [MD]: 0.63 serves/day 95% CI = 0.27–0.98), fruit intake alone (MD = 0.58 serves/day 95% CI = 0.39 to 0.77) and sodium intake (SMD = −0.22 95% CI = −0.44 to −0.01). Improvements were also found for waist circumference [MD = −2.24 centimetres 95% CI = −4.14 to −0.33], body weight (MD = −1.94 kg 95% CI = −2.63 to −1.24) and haemoglobin A1c (MD = −0.17% 95% CI = −0.29 to −0.04). Validity of digital assessment tools to measure dietary intake were not reported. The quality of evidence was considered to have low to moderate certainty. Modest improvements in diet and clinical outcomes may result from intervention via digital health for those with diet‐related chronic conditions. However, additional robust trials with better reporting of digital dietary assessment tools are needed to support implementation within clinical practice.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2014
Publisher: JMIR Publications Inc.
Date: 11-05-2020
Abstract: he Internet of Things (IoT) is a system of wireless, interrelated, and connected digital devices that can collect, send, and store data over a network without requiring human-to-human or human-to-computer interaction. The IoT promises many benefits to streamlining and enhancing health care delivery to proactively predict health issues and diagnose, treat, and monitor patients both in and out of the hospital. Worldwide, government leaders and decision makers are implementing policies to deliver health care services using technology and more so in response to the novel COVID-19 pandemic. It is now becoming increasingly important to understand how established and emerging IoT technologies can support health systems to deliver safe and effective care. The aim of this viewpoint paper is to provide an overview of the current IoT technology in health care, outline how IoT devices are improving health service delivery, and outline how IoT technology can affect and disrupt global health care in the next decade. The potential of IoT-based health care is expanded upon to theorize how IoT can improve the accessibility of preventative public health services and transition our current secondary and tertiary health care to be a more proactive, continuous, and coordinated system. Finally, this paper will deal with the potential issues that IoT-based health care generates, barriers to market adoption from health care professionals and patients alike, confidence and acceptability, privacy and security, interoperability, standardization and remuneration, data storage, and control and ownership. Corresponding enablers of IoT in current health care will rely on policy support, cybersecurity-focused guidelines, careful strategic planning, and transparent policies within health care organizations. IoT-based health care has great potential to improve the efficiency of the health system and improve population health.
Publisher: SAGE Publications
Date: 11-04-2023
DOI: 10.1177/1357633X231169055
Abstract: This brief editorial describes an emerging area of machine learning technology called large language models (LLMs). LLMs, such as ChatGPT, are the technological disruptor of this decade. They are going to be integrated into search engines (Bing and Google) and into Microsoft products in the coming months. They will therefore fundamentally change the way patients and clinicians access and receive information. It is essential that telehealth clinicians are aware of LLMs and appreciate their capabilities and limitations.
Publisher: JMIR Publications Inc.
Date: 15-06-2017
Abstract: elehealth-delivered dietary interventions are effective for chronic disease management and are an emerging area of clinical practice. However, to apply interventions from the research setting in clinical practice, health professionals need details of each intervention component. he aim of this study was to evaluate the completeness of intervention reporting in published dietary chronic disease management trials that used telehealth delivery methods. ligible randomized controlled trial publications were identified through a systematic review. The completeness of reporting of experimental and comparison interventions was assessed by two independent assessors using the Template for Intervention Description and Replication (TIDieR) checklist that consists of 12 items including intervention rationale, materials used, procedures, providers, delivery mode, location, when and how much intervention delivered, intervention tailoring, intervention modifications, and fidelity. Where reporting was incomplete, further information was sought from additional published material and through email correspondence with trial authors. ithin the 37 eligible trials, there were 49 experimental interventions and 37 comparison interventions. One trial reported every TIDieR item for their experimental intervention. No publications reported every item for the comparison intervention. For the experimental interventions, the most commonly reported items were location (96%), mode of delivery (98%), and rationale for the essential intervention elements (96%). Least reported items for experimental interventions were modifications (2%) and intervention material descriptions (39%) and where to access them (20%). Of the 37 authors, 14 responded with further information, and 8 could not be contacted. any details of the experimental and comparison interventions in telehealth-delivered dietary chronic disease management trials are incompletely reported. This prevents accurate interpretation of trial results and implementation of effective interventions in clinical practice.
Publisher: MDPI AG
Date: 11-12-2017
DOI: 10.3390/NU9121345
Publisher: JMIR Publications Inc.
Date: 10-11-2020
DOI: 10.2196/20135
Abstract: The Internet of Things (IoT) is a system of wireless, interrelated, and connected digital devices that can collect, send, and store data over a network without requiring human-to-human or human-to-computer interaction. The IoT promises many benefits to streamlining and enhancing health care delivery to proactively predict health issues and diagnose, treat, and monitor patients both in and out of the hospital. Worldwide, government leaders and decision makers are implementing policies to deliver health care services using technology and more so in response to the novel COVID-19 pandemic. It is now becoming increasingly important to understand how established and emerging IoT technologies can support health systems to deliver safe and effective care. The aim of this viewpoint paper is to provide an overview of the current IoT technology in health care, outline how IoT devices are improving health service delivery, and outline how IoT technology can affect and disrupt global health care in the next decade. The potential of IoT-based health care is expanded upon to theorize how IoT can improve the accessibility of preventative public health services and transition our current secondary and tertiary health care to be a more proactive, continuous, and coordinated system. Finally, this paper will deal with the potential issues that IoT-based health care generates, barriers to market adoption from health care professionals and patients alike, confidence and acceptability, privacy and security, interoperability, standardization and remuneration, data storage, and control and ownership. Corresponding enablers of IoT in current health care will rely on policy support, cybersecurity-focused guidelines, careful strategic planning, and transparent policies within health care organizations. IoT-based health care has great potential to improve the efficiency of the health system and improve population health.
Publisher: Springer Science and Business Media LLC
Date: 14-01-2022
DOI: 10.1186/S12875-021-01595-6
Abstract: Improving the patient experience is one of the quadruple aims of healthcare. Therefore, understanding patient experiences and perceptions of healthcare interactions is paramount to quality improvement. This integrative review aimed to explore how patients with chronic conditions experience Interprofessional Collaborative Practice in primary care. An integrative review was conducted to comprehensively synthesize primary studies that used qualitative, quantitative, and mixed methods. Databases searched were Medline, Embase, CINAHL and Web of Science on June 1st, 2021. Eligible studies were empirical full-text studies in primary care that reported experiences or perceptions of Interprofessional Collaborative Practice by adult patients with a chronic condition, in any language published in any year. Quality appraisal was conducted on included studies using the Mixed Method Appraisal Tool. Data on patients’ experiences and perceptions of Interprofessional Collaborative Practice in primary care were extracted, and findings were thematically analyzed through a meta-synthesis. Forty-eight ( n = 48) studies met the inclusion criteria with a total of n = 3803 participants. Study quality of in idual studies was limited by study design, incomplete reporting, and the potential for positive publication bias. Three themes and their sub-themes were developed inductively: (1) Interacting with Healthcare Teams, subthemes: widening the network, connecting with professionals, looking beyond the condition, and overcoming chronic condition collectively (2) Valuing Convenient Healthcare, subthemes: sharing space and time, care planning creates structure, coordinating care, valuing the general practitioner role, and affording healthcare (3) Engaging Self-care, subthemes: engaging passively is circumstantial, and, engaging actively and leading care. Patients overwhelmingly had positive experiences of Interprofessional Collaborative Practice, signaling it is appropriate for chronic condition management in primary care. The patient role in managing their chronic condition was closely linked to their experience. Future studies should investigate how the patient role impacts the experience of patients, carers, and health professionals in this context. PROSPERO: CRD42020156536.
Publisher: Frontiers Media SA
Date: 12-03-2021
Abstract: Background: Improving diet quality in chronic kidney disease (CKD) is challenging due to a myriad of competing recommendations. Patient-centered goal setting can facilitate dietary behavior change however, its role in improving diet quality in CKD has not been investigated. Aim: The aim of the study is to evaluate the effects of goal setting on improving diet quality in stages 3–4 CKD. Methods: Forty-one participants completed a 6-month dietitian-led telehealth (combined coaching calls and text messages) intervention as part of a larger RCT. Participants set one to two diet-related SMART goals and received weekly goal tracking text messages. Dietary intake was assessed using the Australian Eating Survey at baseline, 3, and 6 months, with diet quality determined using the Alternate Healthy Eating Index (AHEI). Results: Significant improvements in AHEI (+6.9 points 95% CI 1.2–12.7), vegetable (+1.1 serves 95% CI 0.0–2.3) and fiber intake (+4.2 g 95% CI 0.2–8.2) were observed at 3 months in participants setting a fruit and/or vegetable goal, compared with those who did not. However, no significant or meaningful changes were observed at 6 months. No other goal setting strategy appeared in effect on diet intake behavior or clinical outcomes in this group of CKD participants. Conclusions: Patient-centered goal setting, particularly in relation to fruit and vegetable intake, as part of a telehealth coaching program, significantly improved diet quality (AHEI), vegetable and fiber intake over 3 months. More support may be required to achieve longer-term behavior change in stages 3–4 CKD patients.
Publisher: Mary Ann Liebert Inc
Date: 07-2006
Abstract: HIV-1 infection of cells of macrophage lineage impairs a number of effector functions performed by these cells, including phagocytosis of opsonized pathogens. In this study we investigate the effects of HIV-1 on the mechanism of complement (C')-mediated phagocytosis by human monocyte-derived macrophages (MDM). Using C'-opsonized sheep red blood cells (sRBC) as targets, we demonstrate that phagocytosis is inhibited by HIV-1 infection in vitro. Inhibition is not due to downregulation of surface C' receptors (R) or altered binding of C'-opsonized targets to HIV-1-infected MDM, suggesting a postreceptor-mediated mechanism of suppression. Having shown that increased levels of intracellular cAMP in uninfected MDM inhibit phagocytosis, we demonstrate that HIV-1 infection of MDM is associated with increased intracellular cAMP. Using the adenylate cyclase inhibitors 2',5'-dideoxyadenosine and MDL-12,330A, we show that phagocytosis by HIV-1- infected MDM can be restored by inhibition of cAMP production. Defective phagocytosis by HIV-1-infected MDM did not correlate with prostaglandin secretion, and was less in uninfected MDM within the HIV-1-infected cell culture suggesting a minimal bystander effect. Inhibition required viral entry but not active viral replication, as shown by use of the antiretroviral drug lamivudine. Hence, our study suggests that HIV-1 impairs C'R-mediated phagocytosis in MDM by elevating intracellular cAMP levels, independent of prostaglandin secretion, and contributes to our understanding of how HIV-1 impairs cell-mediated immunity.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 2008
No related grants have been discovered for Jaimon Kelly.