ORCID Profile
0000-0001-5935-7328
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University of Wollongong
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Publisher: Springer Science and Business Media LLC
Date: 12-03-2020
DOI: 10.1186/S12882-020-01731-X
Abstract: Chronic kidney disease (CKD) is growing population health concern worldwide, and with early identification and effective management, kidney disease progression can be slowed or prevented. Most patients with risk factors for chronic kidney disease are treated within primary healthcare. Therefore, it is important to understand how best to support primary care providers (PC-P) to detect and manage chronic kidney disease. The aim of this systematic review was to evaluate barriers and enablers to the diagnosis and management of CKD in primary care. A systematic review of qualitative research on the barriers and/or enablers to detection and/or management of CKD in adults within primary healthcare was conducted. The databases Medline (EBSCO), PubMed, Cochrane CENTRAL, CINAHL (EBSCO) and Joanna Briggs Institute Evidence Based Practice (Ovid) were searched until 27th August 2019. Barriers and/or enablers reported in each study were identified, classified into themes, and categorised according to the Theoretical Domains Framework. A total of 20 studies were included in this review. The most commonly reported barriers related to detection and management of CKD in primary care were categorised into the ‘Environmental context and resources’ domain ( n = 16 studies). Overall, the most common barrier identified was a lack of time ( n = 13 studies), followed by a fear of delivering a diagnosis of CKD, and dissatisfaction with CKD guidelines (both n = 10 studies). Overall, the most common enabler identified was the presence of supportive technology to identify and manage CKD ( n = 7 studies), followed by the presence of a collaborative relationship between members of the healthcare team ( n = 5 studies). This systematic review identified a number of barriers and enablers which PC-P face when identifying and managing CKD. The findings of this review suggest a need for time-efficient strategies that promote collaboration between members of the healthcare team, and practice guidelines which consider the frequently co-morbid nature of CKD. Enhanced collaboration between PC-P and nephrology services may also support PC-Ps when diagnosing CKD in primary care, and facilitate improved patient self-management.
Publisher: Wiley
Date: 03-02-2022
DOI: 10.1111/NEP.14025
Publisher: Wiley
Date: 29-07-2021
DOI: 10.1111/APT.16549
Abstract: Poor dietary intake is associated with the development of malnutrition, micronutrient deficiencies, anaemia and osteoporosis in in iduals with inflammatory bowel disease. While trials are underway to manipulate the diet of people with IBD, there has been no comprehensive systematic review of the dietary intake of adults with IBD. To conduct a systematic evaluation and meta‐analysis of the dietary intake of adults with IBD, including macronutrients, micronutrients and food group data. CINAHL, Embase, Medline and Scopus were searched from 1 January 2000 to 25 September 2020 for cohort, case–control or cross‐sectional studies that reported usual dietary intake in adults. Data were pooled and reported as weighted mean intake for: all adults with IBD Crohn's disease ulcerative colitis active disease remission males females. A random‐effects meta‐analysis model compared intake with healthy in iduals. Forty studies were identified and 19 were included in the meta‐analysis. All subgroups of adults with IBD consumed inadequate energy (mean intake in adults with IBD 1980 ± 130 kcal), fibre (14 ± 4 g), folate (246 ± 33 mg) and calcium (529 ± 114 mg) per day. Intake of breads and cereals, legumes, fruit, vegetables and dairy were inadequate. Compared to healthy in iduals, adults with IBD consume significantly less dietary fibre (SMD −0.59 95% CI: −0.73, −0.46). This review provides improved clarity about the dietary intake of adults with IBD. Future attention is required to improve diet quality and increase understanding of factors influencing dietary intake in IBD.
Publisher: Informa UK Limited
Date: 09-10-2015
DOI: 10.1080/10810730.2015.1080329
Abstract: Inadequate health literacy in people with chronic kidney disease (CKD) is associated with poorer disease management and greater complications. There are limited data on the health literacy deficits of people with CKD. The aim of this study was to investigate the types and extent of health literacy deficits in patients with CKD using the multidimensional Health Literacy Management Scale (HeLMS) and to identify associations between patient characteristics and the domains of health literacy measured by the HeLMS. Invitations to participate were sent to patients with CKD attending the renal unit of a regional Australian hospital. These patients included predialysis, dialysis (peritoneal and hemodialysis), and kidney transplant patients. This study identified that inadequate health literacy--especially in the domains relating to attending to one's health needs, understanding health information, social support, and socioeconomic factors--was common. Male gender and education level were significantly associated with inadequate health literacy. The type and extent of health literacy deficits varied among CKD groups, and transplant patients had more deficits than other CKD patient groups. This study provides useful information for health professionals treating patients with CKD, especially with regard to the design of self-management interventions and health information.
Publisher: Wiley
Date: 08-10-2023
Publisher: Elsevier BV
Date: 09-2020
DOI: 10.1053/J.JRN.2019.10.002
Abstract: Constipation is common in patients with end-stage kidney disease. Nondrug strategies to manage constipation are challenging because of dietary potassium, phosphate, and fluid restrictions. Nuts are a high-fiber food but are excluded from the diet because of the high potassium and phosphate content. The aim of this study was to examine the safety and efficacy of using nuts to improve constipation in adults undertaking hemodialysis (HD). Adult patients undertaking HD were recruited to this nonrandomized, 10-week repeated measures, within-subject, pragmatic clinical trial, conducted in two HD units. The intervention consisted of consumption of 40g of raw almonds daily for four weeks, followed by a two-week washout and four-week control period. The primary safety outcome measures were change in predialysis serum potassium and phosphate levels. The primary efficacy outcome was reduction in constipation, measured using the Bristol Stool Form Scale and Palliative Care Outcome Scale (POS-S) renal symptom score. Secondary outcomes included quality of life, selected uremic toxins, cognition, gut microbiota profile, and symptom burden. Twenty patients completed the trial (median age: 67 [interquartile range: 57.5-77.8] years, 51% male). After controlling for dialysis adequacy, anuria, dietary intake, bicarbonate, and parathyroid hormone, there were no statistically significant changes in serum potassium (P = 0.21) or phosphate (P = 0.16) associated with daily consumption of almonds. However, statistically significant improvements in constipation were seen at weeks 2, 3, 4, and 10. There were statistically significant improvements in quality of life (P = 0.030), overall symptom burden (P = 0.002), vomiting (P = 0.020), itching (P = 0.006), and skin changes (P = 0.002). Daily consumption of almonds for four weeks was safe, effective, and well tolerated. Improvements in quality of life and symptom burden warrant further research to elucidate potential mechanisms. The findings support the potential reinclusion of foods such as nuts into the diet of patients who underwent HD.
Publisher: Wiley
Date: 02-07-2018
Abstract: Dietary modification is integral to the management of end stage kidney disease. However, adherence to the renal diet is poor. Few studies have explored the perspectives of renal dietitians and how they work with patients to facilitate dietary change. The objectives of this study were to explore the experiences of renal dietitians about educating patients with end stage kidney disease and to describe the strategies perceived to help patients understand the renal diet. Semi-structured interviews based on Sensemaking theory were conducted with renal dietitians (n = 27) working in Australia and New Zealand from a range of metropolitan, regional and remote areas. Five major themes across two categories were derived from the data. The renal dietitians in this study experienced feelings of frustration, frequently worked in practice environments with limited or inadequate resources and perceived that establishing trust and demonstrating empathy were important to sense making. Renal dietitians helped patients make sense of and understand the diet by clarifying ambiguities and conflicting information and simplifying complexity by using simple explanations, in idualised advice and practical support. These strategies were considered critical to the renal diet sense making process. The experience of providing renal diet advice to adults with end stage kidney disease was emotionally and professionally challenging. Alternative approaches to patient education may help dietitians to empower patients to better understand the renal diet. Further research exploring the experiences of learning about the renal diet from the patient and carer perspective would also help to inform future alternative approaches.
Publisher: Wiley
Date: 29-07-2022
Abstract: To (i) describe the prevalence of malnutrition among a cohort of central Australian, predominantly Indigenous, haemodialysis patients and (ii) determine the sensitivity and specificity of the Patient Generated Subjective Global Assessment total score for identification of malnutrition in these patients. Cross‐sectional observational study of all patients attending haemodialysis units within the Central Australia Health Service. Patients were assessed using the Patient‐Generated Subjective Global Assessment. Chi‐Square tests were used to determine the association between nutritional status and location, age and gender. Receiver Operator Characteristic curves were used to ascertain the predictive validity for malnutrition of the total score. Indigenous patients comprised 98% of study haemodialysis patients ( n = 249/253). One third were male, and 72% were aged between 30 and 59 years. Approximately 29% (74/253) were malnourished, and 93% (69/74) had a total score ≥ 4. The most frequently reported problems that kept malnourished patients from eating were early satiety (32%), no appetite (31%), diarrhoea (26%) and dental problems (24%). Money problems were reported by 32%, as were transport (20%) and depression (19%). The traditional tool cut off score of ≥9 had low sensitivity (50%) for detecting malnutrition. Instead, a score ≥ 3 is suggested due to a higher sensitivity (96%) and specificity (45%). Malnutrition was found to be common, and we suggest using a Patient‐Generated Subjective Global Assessment total score of ≥3 to improve the identification of malnourished in iduals in this cohort of predominantly Indigenous haemodialysis patients. This will significantly increase referrals for dietetic intervention.
Publisher: Wiley
Date: 08-2022
DOI: 10.1111/IMJ.15542
Abstract: Renal resistive index (RRI), which reflects intrarenal arterial impedance, is routinely measured when undertaking renal Doppler ultrasonography (RDU). Increased RRI has been suggested to reflect renal parenchymal disease and imply risk of kidney disease progression. But this has been disputed and extra‐renal haemodynamic factors rather than intra‐renal factors have been proposed to determine RRI. To investigate the relationship between elevated RRI and presence of chronic kidney disease (CKD), and examine whether elevated RRI at baseline is associated with decline in estimated glomerular filtration rate (eGFR) on follow up. This retrospective observational study examined the association of elevated RRI ( .7) with the presence of CKD (eGFR 60 mL/min for months), demographic and clinical factors in multivariable models. We also examined the effect of elevated RRI on eGFR decline on follow up using mixed models. Of the 346 patients undergoing RDU (median age 69.7 years 46.2% male), 180 had elevated RRI. There was a strong inverse association between RRI and eGFR at baseline, 1 and 2 years (rho = −0.53, −0.51, −0.53, all P 001). Elevated RRI was independently predicted by older age (odds ratio 3.29 95% confidence interval 2.25–4.8 P 0.001) and diabetes (odds ratio 2.65 95% confidence interval 1.21–5.80 P = 0.015), but not CKD using multivariate logistic regression. Decline of eGFR was not different between RRI categories on follow up. Elevated RRI was predicted by older age and diabetes, but not by the presence of CKD. Baseline RRI was not associated with eGFR decline.
Publisher: Wiley
Date: 23-02-2016
DOI: 10.1111/AJO.12447
Abstract: The Australasian Diabetes in Pregnancy Society (ADIPS) has recently endorsed the World Health Organization (WHO) terminology and classification of hyperglycaemia in pregnancy. The prevalence is likely to increase, but no prospective data are available for a representative Australian population. To determine the prevalence of hyperglycaemia in pregnancy (HIP) using results from both the public and private sectors in a population that has a similar ethnicity to the overall Australian population. The results of all pregnancy oral glucose tolerance tests (POGTT) in the public sector and by a dominant private pathology provider in a major city have been prospectively collected for a three-year period and analysed using the ADIPS (WHO) criteria. The prevalence of hyperglycaemia in pregnancy (HIP) was 13.1% with diabetes mellitus in pregnancy (DIP) being 0.4% and gestational diabetes mellitus (GDM) being 12.7%. The new criteria will diagnose about one-third more women with GDM than the previous ADIPS criteria. This will have resource and health implications. Focussed local health economic data will be important.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Wiley
Date: 13-03-2015
Publisher: Wiley
Date: 16-02-2017
DOI: 10.1111/JHN.12466
Abstract: Dietary modification is critical in the self-management of chronic kidney disease. The present study describes the accuracy, quality and health literacy demand of renal diet information for adults with kidney disease obtained from the Internet and YouTube (www.youtube.com). A comprehensive content analysis was undertaken in April and July 2015 of 254 eligible websites and 161 YouTube videos. The accuracy of the renal diet information was evaluated by comparing the key messages with relevant evidence-based guidelines for the dietary management of people with kidney disease. The DISCERN tool (www.discern.org.uk) was used to evaluate the quality of the material. Health literacy demand was evaluated using the Patient Education Material Assessment Tool (rofessionals revention-chronic-care/improve/self-mgmt emat/index.html) and seven validated readability calculators. The most frequent renal diet topic found online was generic dietary information for people with chronic kidney disease. The proportion of renal diet information obtained from websites that was accurate was 73%. However, this information was mostly of poor quality with extensive shortcomings, difficult to action and written with a high health literacy demand. By contrast, renal diet information available from YouTube was highly understandable and actionable, although only 18% of the videos were accurate, and a large proportion were of poor quality with extensive shortcomings. The most frequent authors of accurate, good quality, understandable, material were government bodies, dietitians, academic institutions and medical organisations. Renal diet information found online that is written by government bodies, dietitians, academic institutions and medical organisations is recommended. Further work is required to improve the quality and, most importantly, the actionability of renal diet information found online.
Publisher: Wiley
Date: 18-07-2019
Publisher: MDPI AG
Date: 28-06-2023
DOI: 10.3390/NU15132927
Abstract: Dementia is a common syndrome in older people. Dementia alters eating behaviors, hunger and thirst cues, swallow function, ability to self-feed, and recognition and interest in food. There is significant variation in the reported prevalence of malnutrition among older people who live in long-term care. The aim was to conduct a systematic literature review and meta-analysis of the prevalence of malnutrition in those with dementia living in long-term care using a validated nutrition assessment tool. Scopus, Web of Science, CINAHL, and Medline were searched. A random effects model was used to determine the prevalence and risk of malnutrition. Data were retrieved from 24 studies. Most of the studies were from Europe or South Asia. The prevalence of malnutrition ranged from 6.8 to 75.6%, and the risk of malnutrition was 36.5–90.4%. The pooled prevalence of malnutrition in those with dementia in long-term care was 26.98% (95% CI 22.0–32.26, p 0.0001, I2 = 94.12%). The pooled prevalence of the risk of malnutrition in those with dementia was 57.43% (95% CI 49.39–65.28, p 0.0001, I2 = 97.38%). Malnutrition is widespread in those with dementia living in long-term care. Further research exploring malnutrition in other industrialized countries using validated assessment tools is required.
Publisher: MDPI AG
Date: 2023
DOI: 10.3390/KIDNEYDIAL3010002
Abstract: (1) Background: Pain is a prevalent and debilitating symptom associated with kidney failure. However, the impact of pain on quality of life remains unclear. We aimed to identify the prevalence, severity and characteristics of people undertaking dialysis impacted by pain and explore the lived experience of pain (2) Methods: A cross-sectional survey was administered to people undertaking haemodialysis or via telephone to those undertaking peritoneal and home haemodialysis in a single tertiary centre. Open-ended questions were analysed using thematic analysis. (3) Results: Responses were received from 131 participants (response rate 66.8%). Most were undergoing haemodialysis (87.0%). Pain was present in 92% (n = 121) of patients with 62% (n = 81) reporting pain as severe to excruciating. Common sites of pain were joints, muscle cr s, headaches, fistula pain, non-specific back pain and neuropathy. The overarching theme from the thematic analysis was that pain was a “debilitating and accepted burden” (4) Conclusions: Pain is highly prevalent, severe and debilitating in those on dialysis. There is a need for health care providers to be proactive and attentive to the management of pain. More research is needed to identify effective treatment approaches to decrease pain burden and improve the quality of life in those with kidney failure.
Publisher: MDPI AG
Date: 04-01-2022
DOI: 10.3390/NU14010216
Abstract: The purpose of this study was to explore the perspective of renal dietitians regarding plant-based diets for chronic kidney disease (CKD) management and evaluate the acceptability of a hypothetical plant-based dietary prescription aiming for the consumption of 30 unique plant foods per week. This study used an exploratory mixed methods design. Forty-six renal dietitians participated in either an online survey (n = 35) or an in-depth interview (n = 11). Dietitians perceived that plant-based diets could address multiple clinical concerns relevant to CKD. Forty percent of survey respondents reported the hypothetical dietary prescription was realistic for people with CKD, 34.3% were unsure, and 25.7% perceived it as unrealistic. Strengths of the hypothetical prescription included shifting the focus to whole foods and using practical resources like recipes. Limited staffing, time, and follow-up opportunities with patients, as well as differing nutrition philosophies were the most commonly reported challenges to implementation while a supportive multidisciplinary team was identified as an important enabler. To increase patient acceptance of plant-based dietary approaches, education about plant food benefits was recommended, as was implementing small, incremental dietary changes. Successful implementation of plant-based diets is perceived to require frequent patient contact and ongoing education and support by a dietitian. Buy-in from the multidisciplinary team was also considered imperative.
Publisher: Public Library of Science (PLoS)
Date: 28-04-2022
DOI: 10.1371/JOURNAL.PONE.0267290
Abstract: Remaining physically active is important to patients undertaking dialysis, however, clinical recommendations regarding exercise type, timing, intensity, and safety precautions vary. The purpose of this scoping review was to analyse and summarise recommendations for physical activity and exercise for people undertaking dialysis and identify areas that require further research or clarification. A scoping review of literature from five bibliographic databases (Medline, Scopus, Web of Science, CINAHL, and SPORTDiscus) was conducted. Eligible articles included consensus guidelines, position statements, reviews, or clinical practice guidelines that included specific physical activity and exercise recommendations for people undertaking dialysis. Key search terms included "kidney disease" OR "kidney failure" OR "chronic kidney disease" OR "end stage kidney disease" AND guideline* OR consensus OR "position statement" OR prescription OR statement AND exercise OR "physical activity". Hand searching for relevant articles in all first twenty quartile 1 journals listed on SCImago under ‘medicine—nephrology’ and ‘physical therapy, sports therapy and rehabilitation’ using the terms ‘exercise and dialysis’ was undertaken. Finally, home pages of key societies and professional organisations in the field of sports medicine and nephrology were searched. The systematic search strategy identified 19 articles met the inclusion criteria. Two were specific to pediatric dialysis and three to peritoneal dialysis. Whilst many publications provided recommendations on aerobic exercise, progressive resistance training and flexibility, few provided explicit guidance. Recommendations for the intensity, duration and frequency of aerobic and resistance training varied. Discrepancies or gaps in guidance about precautions, contraindications, termination criteria, progression, and access site precautions were also apparent. Future guidelines should include specific guidance regarding physical activity, safety precautions, and timing and intensity of exercise for in iduals who undertake dialysis. Collaborative multidisciplinary guideline development and appropriate exercise counselling may lead to increased participation in physical activity and exercise and facilitate better patient outcomes.
Publisher: Informa UK Limited
Date: 13-11-2019
DOI: 10.1080/21551197.2019.1689882
Abstract: This retrospective observational study evaluated the association between nutritional status, functional ability and discharge outcomes. Data from 1430 older rehabilitation patients (43% male, median age 79 years, interquartile range: 74-84) were analyzed. One fifth (20.6%,
Publisher: Wiley
Date: 17-10-2017
DOI: 10.1111/NEP.12892
Abstract: The aim of this study was to compare the extent of cogntive impairment and the types of cognitive deficits in an Australian cohort of four patient groups with end stage kidney disease. Characteristics predicting the presence of cognitive impairment were also evaluated. Observational cross-sectional study of 155 patients with end stage kidney disease are recruited from a regional Australian renal unit. Eligible participants included those whose estimated Glomerular Filtration Rate was < 30 ml/min per 1.73 m The extent of cognitive impairment varied between the four groups with end stage kidney disease. Factors predicting the presence of cognitive impairment included undertaking dialysis, age ≥65, male gender and the presence of diabetes or cerebrovascular disease. Deficits in executive function, attention, language, visuospatial skills, memory and orientation were common among the study participants, and the extent of these deficits varied between groups. Limitations to the study included the cross-sectional design, and that the presence of confounders like depression were not recorded. The impact of disparities in the cognitive capabilities identified in this study are likely to be far reaching. Tailoring of education and self-management programmes to the cognitive deficits of in iduals is required.
Publisher: Wiley
Date: 30-01-2022
DOI: 10.1111/JORC.12409
Abstract: People with chronic kidney disease are often multimorbid and have complex psychosocial needs. For health professionals to deliver holistic, person‐centred care to in iduals and their carers living with this multifaceted disease, they are required to communicate complex information and problem solve in a multifactorial health and disease context. To explore the perspectives and experiences of tertiary care multidisciplinary team members and primary care providers of health care to people with chronic kidney disease identify opportunities to innovate and improve the coordinated delivery of health services. The qualitative study design used purposive s ling to recruit 39 health professionals, working in the primary and tertiary sector in a regional Australian health district. Participants included general practitioners, renal and general practice nurses, dietitians, nephrologists and social workers. The data were collected through semistructured interviews and analysed using a relativist ontological position and directed content analysis approach. Analysis of interviews was undertaken by three independent researchers and key themes were derived via consensus. A common goal to deliver person‐centred in idualised care was evident among health care professionals. However a deficit in shared understanding of the disease within and between disciplines was identified. The complex nature of chronic kidney disease requires up‐skilling of health professionals to ensure patient education is targeted to in idual health contexts and motivates self‐management. Improved communication and comprehension might best be achieved across disciplines with an integrated approach to delivery of primary health care to in iduals living with early‐stage kidney disease.
Publisher: Wiley
Date: 28-11-2018
DOI: 10.1111/NEP.13188
Abstract: Patients with progressive chronic kidney disease (CKD) develop positive phosphate balance that is associated with increased cardiovascular risk and mortality. Modification of dietary phosphate is a commonly used strategy to improve outcomes but is complicated by the need for adequate dietary protein. Surprisingly, the evidence for patient-level benefits from phosphate restriction is tenuous, and the justification for using any phosphate binder for pre-dialysis patients is questionable. The evidence for dietary phosphate modification was reviewed, along with the possible role of a smart phone application (app) that provides information on phosphate, sodium, potassium and nutrients in over 50 000 Australian foods. A pilot study of healthy participants assigned to dietetic advice and standard diet sheets, or dietetic advice, diet sheets and use of the smart phone app was performed. Following baseline studies, 25 participants commenced the sodium and phosphate restricted diet. After 2 weeks, both groups showed non-significant trends to reduction in urinary phosphate and sodium. App users referred to information on the app more frequently than the control group participants referred to written instructions, found referring to the app more convenient, felt they learned more new information, were more motivated to maintain the diet and were more likely to recommend their information source to family or friends (all P < 0.05). Maintaining phosphate balance remains an important goal of CKD management, although diets incorporating very low phosphate and protein contents may worsen patient outcomes. For selected patients, a smart phone app may improve dietary acceptance and compliance.
Publisher: Springer Science and Business Media LLC
Date: 10-2010
DOI: 10.1007/S12603-010-0307-3
Abstract: Routine nutrition screening is recommended for all older patients admitted to hospital however data on the prevalence of malnutrition in rehabilitation settings is sparse. This study assessed the nutritional status of older patients admitted to rehabilitation hospitals over a 5 year period and described the association between nutritional status and length of hospital stay (LOS) in this context. The usefulness of a recently revised version of the shortened MNA (MNA-SF) was also investigated. A retrospective analysis was conducted of patients aged 65 + y admitted to two rehabilitation hospitals in New South Wales, Australia between 1st March 2003-30th June 2004, and 11th January 2005-10th December 2008. Nutritional status was determined on admission by trained dietitians using the full MNA instrument and the MNA-SF. Information on diagnosis-related grouping and length of stay (LOS) was obtained. Data was available for 2076 patients with a mean age of 80.6 (27.7) y. Thirty-three percent and 51.5% of patients were classified as malnourished and at nutritional risk, respectively. Controlling for date of admission and diagnosis related grouping, LOS was higher in malnourished and at risk groups compared to their well nourished peers (P < 0.001) by 18.5 and 12.4 days, respectively. MNA-SF demonstrated high sensitivity but relatively low specificity against the full MNA. The majority of older patients in the rehabilitation setting are nutritionally compromised which adversely influences LOS. In order to encourage more widespread screening, the MNA-SF may be able to replace the full MNA.
Publisher: Wiley
Date: 04-05-2016
DOI: 10.1111/AJO.12473
Abstract: Knowledge of the fasting plasma glucose of healthy women may assist in the setting of treatment targets for women with hyperglycaemia in pregnancy (HIP). This study examines the pregnancy glucose tolerance test results of 3344 women without HIP collected over a three-year period. The median fasting plasma glucose was 4.4 mmol/L with an interquartile range of 4.2-4.6 mmol/L and a 5th to 95th centile of 3.8-4.9 mmol/L. As the diagnostic fasting glucose level for HIP is ≥5.1 mmol/L, these data support a treatment target of ≤5.0 mmol/L.
Publisher: Wiley
Date: 26-08-2019
DOI: 10.1111/JCH.13685
Publisher: MDPI AG
Date: 20-07-2021
DOI: 10.3390/NU13072472
Abstract: Food manufacturers are increasingly substituting potassium chloride (KCl) in food products so as to reduce the sodium chloride content. Bread and bread products are common staple foods in many Western households and are a target for recipe reformulation using KCl. Given that chronic kidney disease (CKD) is a medical condition of global importance that requires dietary potassium restriction in the later stages, we sought to evaluate the impact and safety of varying levels of KCl substitution in bread products. We undertook a secondary analysis of dietary data from the National Nutrition and Physical Activity Survey 2011–2012 for 12,152 participants (154 participants with CKD). The sodium chloride content in bread and bread-based products was substituted with 20%, 30%, and 40% of KCl. The contribution of these alterations in the dietary potassium intake to the total daily potassium intake were then examined. The replacement of sodium in bread with varying amounts of KCl (20%, 30%, and 40%) resulted in one third of people with CKD exceeding the safe limits for dietary potassium consumption (31.8%, 32.6%, and 33%, respectively). KCl substitution in staple foods such as bread and bread products have serious and potentially fatal consequences for people who need to restrict dietary potassium. Improved food labelling is required for consumers to avoid excessive consumption.
Publisher: Springer Science and Business Media LLC
Date: 12-02-2019
Publisher: Wiley
Date: 03-07-2020
DOI: 10.1002/HPJA.373
Abstract: Utilisation of professional health care interpreting services improves the quality and safety of health care among patients with limited English proficiency. Health care interpreter service utilisation is inconsistent and suboptimal in Australia. Evidence of the impact of interpreter service use on patient outcomes and costs is limited. This study aimed to identify the proportion of hospitalised patients who received a health care interpreter during admission and describe the characteristics and outcomes for those requiring interpreter services. A retrospective cohort analysis of linked admitted patient data with internal interpreter audit data. This study included all inpatients in a health district‐wide clinical audit of interpreter service use conducted between July 2016 and March 2018. The dataset comprised 74 patients (including 79 unique hospital stays and 90 episodes) from eight hospitals in one regional health district in New South Wales, Australia. Interpreting services were utilised at least once for 54.4% (n = 43) of admissions. Females were more likely to receive an interpreter (65.1% vs 47.1%, P = .04). Age, preferred language, hospital, Diagnosis‐Related Group partition and comorbidities were not associated with interpreter service utilisation. Differences in length of stay and cost associated with use of interpreter services were not statistically significant after casemix adjustment. Approximately half of those who required an interpreter received one during their hospital stay. Further investigation is needed to establish whether regular clinical audits contributed to this rate of utilisation, which is higher than reported elsewhere in the literature. A detailed understanding of regional interpreting service use with evidence from the literature provides compelling and contextual evidence for change, at the level at which the service is delivered. This supports meaningful action to increase utilisation, and improve the quality and safety of health care delivered to patients with limited English proficiency.
Publisher: MDPI AG
Date: 18-10-2021
DOI: 10.3390/NU13103640
Abstract: Dehydration is common in the elderly, especially when hospitalised. This study investigated the impact of interventions to improve hydration in acutely unwell or institutionalised older adults for hydration and hydration linked events (constipation, falls, urinary tract infections) as well as patient satisfaction. Four databases were searched from inception to 13 May 2020 for studies of interventions to improve hydration. Nineteen studies (978 participants) were included and two studies (165 participants) were meta-analysed. Behavioural interventions were associated with a significant improvement in hydration. Environmental, multifaceted and nutritional interventions had mixed success. Meta-analysis indicated that groups receiving interventions to improve hydration consumed 300.93 mL more fluid per day than those in the usual care groups (95% CI: 289.27 mL, 312.59 mL I2 = 0%, p 0.00001). Overall, there is limited evidence describing interventions to improve hydration in acutely unwell or institutionalised older adults. Behavioural interventions appear promising. High-quality studies using validated rather than subjective methods of assessing hydration are needed to determine effective interventions.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Wiley
Date: 24-09-2017
DOI: 10.1111/JORC.12215
Abstract: People on haemodialysis (HD) are at risk of consuming a poor quality diet. This includes inadequate intake of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA). This study aims to investigate diet quality, with a particular focus on n-3 LCPUFA intake, in a population of incentre HD patients. Dietary intake was measured using three 24 hour recalls the Polyunsaturated food frequency questionnaire (PUFA FFQ) and the Total Diet Score (TDS). Dietary intake was also compared to evidence based practice guidelines (EBPG). Nutritional status was assessed using the Patient Generated Subjective Global Assessment (PG SGA). A total of 32 dialysis patients were recruited, from two regional HD centres in New South Wales, Australia. Diet quality was the main outcome measure. Diet quality of study participants was poor, with the majority not meeting the EBPG for energy, protein and potassium. All participants exceeded the recommended amount of saturated fat. The mean TDS of the dialysis cohort was 10.2, which was significantly higher than the TDS of 9.3 of a healthy disease free cohort (p < 0.05). Positive correlations were found between TDS and LC omega-3 intake (r = 0.392) and TDS and total omega-6 intake (r = 0.363). Only 22% of participants met the suggested dietary target for n-3 LCPUFA intake. Dialysis patients in this study had suboptimal diet quality. Improvements are required for better adherence to the EBPG. Increased consumption of n-3 LCPUFA fatty acids may also be of benefit.
Publisher: MDPI AG
Date: 31-03-2023
DOI: 10.3390/NU15071711
Abstract: Nutritional guidelines recommended limiting dietary phosphorus as part of phosphorus management in patients with kidney failure. Currently, there is no validated phosphorus food frequency questionnaire (P-FFQ) to easily capture this nutrient intake. An FFQ of this type would facilitate efficient screening of dietary sources of phosphorus and assist in developing a patient-centered treatment plan. The objectives of this study were to develop and validate a P-FFQ by comparing it with the 24 hr multi-pass recall. Fifty participants (66% male, age 70 ± 13.3 years) with kidney failure undertaking dialysis were recruited from hospital nephrology outpatient departments. All participants completed the P-FFQ and 24 hr multi-pass recalls with assistance from a renal dietitian and then analysed using nutrient analysis software. Bland–Altman analyses were used to determine the agreement between P-FFQ and mean phosphorus intake from three 24 hr multi-pass recalls. Mean phosphorous intake was 1262 ± 400 mg as determined by the 24 hr multi pass recalls and 1220 ± 348 mg as determined by the P-FFQ. There was a moderate correlation between the P-FFQ and 24 hr multi pass recall (r = 0.62, p = 0.37) with a mean difference of 42 mg (95% limits of agreement: 685 mg −601 mg, p = 0.373) between the two methods. The precision of the P-FFQ was 3.33%, indicating suitability as an alternative to the 24 hr multi pass recall technique. These findings indicate that the P-FFQ is a valid, accurate, and precise tool for assessing sources of dietary phosphorus in people with kidney failure undertaking dialysis and could be used as a tool to help identify potentially problematic areas of dietary intake in those who may have a high serum phosphate.
Publisher: BMJ
Date: 06-2019
DOI: 10.1136/BMJOPEN-2018-027700
Abstract: Patients are presenting to emergency departments (EDs) with increasing complexity at rates beyond population growth and ageing. Intervention studies target patients with 12 months or less of frequent attendance. However, these interventions are not well targeted since most patients do not remain frequent attenders. This paper quantifies temporary and ongoing frequent attendance and contrasts risk factors for each group. Retrospective population-based study using 10 years of longitudinal data. An Australian geographic region that includes metropolitan and rural EDs. 332 100 residents visited any ED during the study period. Frequent attendance was defined as seven or more visits to any ED in the region within a 12-month period. Temporary frequent attendance was defined as meeting this threshold only once, and ongoing more than once. Risk factors for temporary and ongoing frequent attenders were identified using logistic regression models for adults and children. Of 8577 frequent attenders, 80.1% were temporary and 19.9% ongoing (12.9% repeat, 7.1% persistent). Among adults, ongoing were more likely than temporary frequent attenders to be young to middle aged (aged 25–64 years), and less likely to be from a high socioeconomic area or be admitted. Ongoing frequent attenders had higher rates of non-injury presentations, in particular substance-related (OR=2.5, 99% CI 1.1 to 5.6) and psychiatric illness (OR=2.9, 99% CI 1.8 to 4.6). In comparison, children who were ongoing were more likely than temporary frequent attenders to be aged 5–15 years, and were not more likely to be admitted (OR=2.7, 99% CI 0.7 to 10.9). Future intervention studies should distinguish between temporary and ongoing frequent attenders, develop specific interventions for each group and include rigorous evaluation.
Publisher: MDPI AG
Date: 04-08-2023
Abstract: The aim of this paper is to report on the differences in clinical and service engagement outcomes of patients attending the paediatric dietetic outpatient service at a major metropolitan hospital before the outbreak of the coronavirus (using face-to-face care) and during the pandemic (using telehealth). This paper also reports on learning lessons from the rapid implementation of telehealth in this service. This study collected pre- and post-coronavirus pandemic data from 44 paediatric patients. Data on outcomes pre- and post-implementation were analysed. There were no statistically significant differences between pre- and post-coronavirus data for growth (p = 0.92), adherence to dietetic recommendations (p = 0.08) or attendance rate (p = 1.00). This study also found a low uptake of virtual telehealth, technical issues and suboptimal anthropometric data collection associated with this modality of care. Telehealth was not associated with a change in clinical and service engagement outcomes. Thus, telehealth service delivery is not inferior to usual face–face dietetic care and has the potential to be a useful adjunct to usual nutrition care for paediatric health service users after the coronavirus pandemic.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Elsevier BV
Date: 08-2023
Publisher: Elsevier BV
Date: 08-2023
Publisher: Wiley
Date: 30-03-2021
Publisher: Springer Science and Business Media LLC
Date: 11-03-2022
DOI: 10.1007/S00467-021-05389-X
Abstract: Adequate nutrition is integral to optimal health outcomes for children with chronic kidney disease. However, no studies to date have summarised the existing knowledge base on the dietary intake of this patient group. Analyse and summarise evidence regarding the dietary intake of children with chronic kidney disease and identify areas that require further research or clarification. A scoping review of English language articles using four bibliographic databases and a predefined search term strategy. Weighted mean intake for each nutrient was calculated. Eighteen studies were identified (1407 children and 118 healthy controls). Data on socioeconomic status, underreporting of intake and binder use was sparse. Most studies collected dietary information using food records or 24-h recalls. Nutrient data was missing for many subgroups especially transplant and dialysis patients. Protein intake was excessive in all groups where data was reported and varied from 125.7 ± 33% of the recommended dietary allowance in the severe disease group to 391.3 ± 383% in the group with mild kidney disease. Fibre, calcium, iron and vitamin C intake was inadequate for all groups. For children undertaking dialysis, none met the recommended dietary allowance for vitamins C, B1, B2, B3, B5 and B6. Sodium intake was excessive in all groups (> 220% of the recommended dietary allowance). Limited data suggests diet quality is poor, particularly fruit and vegetable intake. This review has identified important subgroups of children with kidney disease where nutrient intake is suboptimal or not well described. Future studies should be conducted to describe intake in these groups. A higher-resolution version of the graphical abstract is available as Supplementary information.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Elsevier BV
Date: 06-2023
Publisher: Springer Science and Business Media LLC
Date: 19-09-2012
Abstract: Older malnourished patients experience increased surgical complications and greater morbidity compared with their well-nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 18 months follow-up. A retrospective analysis of N=2076 patient admissions (65+ years) from two subacute hospitals, New South Wales, Australia. Analysis of outcomes at 18 months, according to nutritional status at index admission, was performed in a subs le of n = 476. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records, included hospital readmission rate, total Length of Stay (LOS), change in level of care at discharge and mortality. Survival analysis, using a Cox proportional hazards model, included age, sex, Major Disease Classification, mobility and LOS at index admission as covariates. At baseline, 30% of patients were malnourished and 53% were at risk of malnutrition. LOS was higher in malnourished and at risk, compared with well-nourished patients (median (interquartile range): 34 (21, 58) 26 (15, 41) 20 (14, 26) days, respectively P<0.001). Hazard rate for death in the malnourished group is 3.41 (95% confidence interval: 1.07-10.87 P = 0.038) times the well-nourished group. Discharge to a higher level of residential care was 33.1%, 16.9% and 4.9% for malnourished, at-risk and well-nourished patients, respectively P ≤ 0.001). Malnutrition in elderly subacute patients predicts adverse clinical outcomes and identifies a need to target this population for nutritional intervention following hospital discharge.
Publisher: Wiley
Date: 27-09-2018
DOI: 10.1111/JORC.12260
Abstract: Dietary modification is an integral part of chronic kidney disease (CKD) management. However, adherence to the renal diet is often suboptimal. The aims of this study were to (i) describe the experiences of patients with CKD and their carers in their process of interpreting and implementing renal dietary advice (ii) to explore strategies they used to make sense of and apply renal diet information and (iii) to develop recommendations for improved clinical practice. To achieve these aims, in idual semi-structured interviews with 26 patients and 10 carers were conducted, using interview questions guided by Sensemaking theory. Six themes emerged from the data which did not differ according to CKD stage, geographic location or renal replacement therapy (RRT) type. The renal diet was perceived by patients and carers to be overwhelming, frustrating and emotionally demanding as well as being complex and challenging. To help make sense of and apply renal dietary advice, participants highly valued the input of the dietitian and patients believed that their carer support was important. In idual problem-solving strategies were developed by participants to help them make sense of the renal diet, and many of them expressed a desire for additional resources and/or support. This study highlights that learning to make sense of renal diet information is an emotionally challenging journey for patients and carers. In addition to utilising the expertise of dietitians, carer support was perceived to be integral to learning and using renal dietary advice. The study describes a number of important problem-solving strategies utilised by patients and carers, as well as recommendations to help improve sensemaking and adherence to the renal diet.
Publisher: Wiley
Date: 28-03-2023
DOI: 10.1111/AJAG.13192
Abstract: This systematic review and meta‐analysis aimed to examine non‐pharmacological interventions for helping people with dementia who experience feeding difficulties in order to improve their nutritional status. The articles were searched using PsycINFO, Medline, PubMed, CINAHL and Cochrane. Two independent investigators critically appraised eligible studies. The PRISMA guidelines and checklist were used. The possibility of risk of bias was assessed using a tool to assess the quality of randomised control trials (RCT) and non‐RCT studies. A narrative synthesis was conducted as a method of synthesis. The Cochrane Review Manager (RevMan 5.4) was used for meta‐analysis. The systematic review and meta‐analysis included seven publications. Six interventions were identified and categorised as: eating ability training for people with dementia, staff training and feeding assistance and support. The meta‐analysis found evidence of the effect of eating ability training on feeding difficulty, quantified by the Edinburgh Feeding Evaluation in Dementia scale (EdFED) with a weighted mean difference of −1.36 (95% confidence interval: −1.84 to −0.89, p 0.001) and on self‐feeding time. A spaced retrieval intervention showed a positive effect on EdFED. The systematic review discovered that while feeding assistance had a positive effect on feeding difficulty, staff training had no effect. According to the meta‐analysis, these interventions had no effect on improving the nutritional status of people with dementia. None of the included RCTs met the Cochrane risk‐of‐bias criteria for randomised trials. This review found that direct training for people with dementia and indirect feeding support from care staff resulted in fewer mealtime difficulties. More RCT studies are needed to determine the efficacy of such interventions.
Publisher: Wiley
Date: 15-01-2017
Abstract: The use of concentrated oral nutrition supplements dispensed in small volumes throughout the day at medication rounds is a common nutrition support strategy. Often termed 'Nutrition as Medication' or NAM, it is associated with excellent rates of patient consumption. However, administration of NAM has been described as suboptimal. The aim of the present study was to identify and explore factors influencing the efficacy of the NAM program from a qualitative perspective. This included exploring issues relating to knowledge, administration and patient consumption from a patient and health professional perspective. Semistructured interviews with patients (n = 7) and eight focus groups with nursing, medical, pharmacy and dietetic staff (n = 63) were conducted. Interviews were conducted in the workplace and were recorded and transcribed verbatim. Data were analysed from a realist theoretical position using the thematic framework approach. Five themes were identified that impact on the efficacy of the NAM program. These include the need for clear role delineation among health professionals regarding responsibility for each aspect of NAM. Other themes that emerged included misconceptions about the importance and relevance of the treatment perceptions of poor palatability and issues associated with the logistics of providing the supplements within the hospital setting. Dietitians should be aware that there are a range of factors that influence the efficacy of the NAM strategy, including the knowledge and values of in idual health professional staff. In addition, increased awareness is required by dietitians regarding the structural barriers to administration and receiving of NAM at the ward level.
Publisher: MDPI AG
Date: 21-06-2023
Abstract: Aim: To evaluate the nutritional adequacy of the hospital haemodialysis menu, quantify the dietary intake of hospitalised haemodialysis patients and explore patient perceptions of the menu. Methods: The menu analysis compared the default menu to reference standards using a one s le t-test via SPSS. Eight hospitalised haemodialysis patients were purposively interviewed using semi-structured interviews. Thematic analysis was used to identify the dominant themes. The participant’s actual dietary intake was calculated and compared to in idual nutrients using evidence-based guidelines. Results: Compared to the reference standards, the default inpatient haemodialysis menu did not provide adequate energy (p 0.001, mean = 8767 kJ/day ± 362), sodium (p 0.001, mean = 72 mmol/day ± 9), potassium (p 0.001, mean = 64 mmol/day ± 4), vitamin C (p ≤ 0.001, mean = 33 mg/day ± 10) and fibre (p 0.001, mean = 26 g/day ± 3). Inadequate intake of energy and protein occurred in half of the participants. Passive acceptance of the menu, environmental and cultural considerations contributed to missed food opportunities impacting the patient experience and limited intake. Conclusions: The profile of the current default inpatient haemodialysis menu impacts the dietary intake and the experience of haemodialysis inpatients. It is recommended that the default menu is optimised in line with evidence-based guidelines for inpatients.
Publisher: Springer Science and Business Media LLC
Date: 05-06-2020
DOI: 10.1186/S12882-020-01805-W
Abstract: There is mounting evidence that in iduals with kidney disease and kidney stones have an abnormal gut microbiota composition. No studies to date have summarised the evidence to categorise how the gut microbiota profile of these in iduals may differ from controls. Synthesis of this evidence is essential to inform future clinical trials. This systematic review aims to characterise differences of the gut microbial community in adults with kidney disease and kidney stones, as well as to describe the functional capacity of the gut microbiota and reporting of diet as a confounder in these studies. Included studies were those that investigated the gut microbial community in adults with kidney disease or kidney stones and compared this to the profile of controls. Six scientific databases (CINHAL, Medline, PubMed, Scopus, Web of Science and Cochrane Library), as well as selected grey literature sources, were searched. Quality assessment was undertaken independently by three authors. The system of evidence level criteria was employed to quantitatively evaluate the alteration of microbiota by strictly considering the number, methodological quality and consistency of the findings. Additional findings relating to altered functions of the gut microbiota, dietary intakes and dietary methodologies used were qualitatively summarised. Twenty-five articles met the eligibility criteria and included data from a total of 892 adults with kidney disease or kidney stones and 1400 controls. Compared to controls, adults with kidney disease had increased abundances of several microbes including Enterobacteriaceae, Streptococcaceae, Streptococcus and decreased abundances of Prevotellaceae, Prevotella, Prevotella 9 and Roseburia among other taxa. Adults with kidney stones also had an altered microbial composition with variations to Bacteroides, Lachnospiraceae NK4A136 group, Ruminiclostridium 5 group , Dorea, Enterobacter, Christensenellaceae and its genus Christensenellaceae R7 group . Differences in the functional potential of the microbial community between controls and adults with kidney disease or kidney stones were also identified. Only three of the 25 articles presented dietary data, and of these studies, only two used a valid dietary assessment method. The gut microbiota profile of adults with kidney disease and kidney stones differs from controls. Future study designs should include adequate reporting of important confounders such as dietary intake to assist with interpretation of findings.
Publisher: Public Library of Science (PLoS)
Date: 29-01-2019
Publisher: Wiley
Date: 19-11-2017
DOI: 10.1111/JORC.12224
Abstract: Malnutrition is a significant problem in those undergoing peritoneal dialysis (PD). Factors such as gastrointestinal (GI) symptoms and the need for a fluid reduced diet can limit tolerance and thereby the efficacy of oral nutritional supplements to treat malnutrition. To evaluate the acceptability and impact of two different forms of oral nutrition supplementation for 16 weeks on nutritional markers and quality of life of malnourished patients undergoing PD. A randomised, within-subject cross-over study. Patients assessed as malnourished or with serum albumin <35 g/l were recruited. Participants were randomised to receive either 200 ml of a 1.25 kcal/ml nutrition supplement or a high protein nutrition supplement bar, for eight weeks. Each group then crossed over to receive the alternative supplement for eight weeks. Total intervention time was 16 weeks. Serum albumin, serum transthyretin and food intake were evaluated at baseline, at 8 and 16 weeks. Subjective Global Assessment, the presence of GI symptoms and quality of life were evaluated at baseline and 16 weeks. Sixteen weeks of nutritional support was associated with statistically significant improvements in weight and a reduction in the proportion of patients who were malnourished. There was no difference in the impact of bars compared with liquid oral nutrition supplementation. Patients preferred the fluid supplement to the bars. Sixteen weeks of nutritional support improved nutritional status in malnourished patients on PD.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/AH16109
Abstract: Objective The aim of the present study was to describe how one regional health service the Illawarra Shoalhaven Local Health District embedded health literacy principles into health systems over a 3-year period. Methods Using a case study approach, this article describes the development of key programs and the manner in which clinical incidents were used to create a health environment that allows consumers the right to equitably access quality health services and to participate in their own health care. Results The key outcomes demonstrating successful embedding of health literacy into health systems in this regional health service include the creation of a governance structure and web-based platform for developing and testing plain English consumer health information, a clearly defined process to engage with consumers, development of the health literacy ambassador training program and integrating health literacy into clinical quality improvement processes via a formal program with consumers to guide processes such as improvements to access and navigation around hospital sites. Conclusions The Illawarra Shoalhaven Local Health District has developed an evidence-based health literacy framework, guided by the core principles of universal precaution and organisational responsibility. Health literacy was also viewed as both an outcome and a process. The approach taken by the Illawarra Shoalhaven Local Health District to address poor health literacy in a coordinated way has been recognised by the Australian Commission on Safety and Quality in Health Care as an exemplar of a coordinated approach to embed health literacy into health systems. What is known about the topic? Poor health literacy is a significant national concern in Australia. The leadership, governance and consumer partnership culture of a health organisation can have considerable effects on an in idual’s ability to access, understand and apply the health-related information and services available to them. Currently, only 40% of consumers in Australia have the health literacy skills needed to understand everyday health information to effectively access and use health services. What does this paper add? Addressing health literacy in a coordinated way has the potential to increase safety and quality of care. This paper outlines the practical and sustainable actions the Illawarra Shoalhaven Local Health District took to partner with consumers to address health literacy and to improve the health experience and health outcomes of consumers. Embedding health literacy into public health services requires a coordinated whole-of-organisation approach it requires the integration of leadership and governance, revision of consumer health information and revision of consumer and staff processes to effect change and support the delivery of health-literate healthcare services. What are the implications for practitioners? Embedding health literacy into health systems promotes equitable, safe and quality healthcare. Practitioners in a health-literate environment adopt consumer-centred communication and care strategies, provide information in a way that is easy to understand and follow and involve consumers and their families in decisions regarding and management of the consumer’s care.
Publisher: CSIRO Publishing
Date: 28-04-2022
DOI: 10.1071/AH21297
Abstract: The impact of poorly written policies in healthcare is enormous, with the potential for significant economic and personal costs. Our local health district embarked on a major revision of policy document development that sought to reframe the process of policy development using health literacy principles. This included mandatory policy development changes that require policy to be written in plain language, at a readability level of grade 10–12. Staff training in plain language writing was undertaken. Consumer and staff feedback was incorporated in policy development. Four elements were critical to this process: effective leadership, effective instruction, practical support, and evidence-driven decisions. Staff responses to the revised processes were overwhelmingly positive and resulted in improved policy readability. The involvement of consumers in policy development has evolved. From this study, we have learned how to improve the governance of policy documents. It is possible for health literacy principles to be embedded in the development and revision of these documents.
Publisher: JMIR Publications Inc.
Date: 31-08-2022
DOI: 10.2196/39909
Abstract: We developed a smartphone app—the SUCCESS (Supporting Culturally and Linguistically Diverse CKD Patients to Engage in Shared Decision-Making Successfully) app—to support Australian adults with kidney failure undertaking dialysis to actively participate in self-management and decision-making. The content of the SUCCESS app was informed by a theoretical model of health literacy that recognizes the importance of reducing the complexity of health information as well as providing skills necessary to access, understand, and act on this information. The purpose of this study is to investigate the efficacy of the SUCCESS app intervention. We designed a multicenter pragmatic randomized controlled trial to compare the SUCCESS app plus usual care (intervention) to usual care alone (control). A total of 384 participants receiving in-center or home-based hemodialysis or peritoneal dialysis will be recruited from six local health districts in the Greater Sydney region, New South Wales, Australia. To avoid intervention contamination, a pragmatic randomization approach will be used for participants undergoing in-center dialysis, in which randomization will be based on the days they receive hemodialysis and by center (ie, Monday, Wednesday, and Friday or Tuesday, Thursday, and Saturday). Participants undergoing home-based dialysis will be in idually randomized centrally using simple randomization and two stratification factors: language spoken at home and research site. Consenting participants will be invited to use the SUCCESS app for 12 months. The primary endpoints, which will be assessed after 3, 6, and 12 months of app usage, are health literacy skills, evaluated using the Health Literacy Questionnaire decision self-efficacy, evaluated using the Decision Self-Efficacy Scale and rates of unscheduled health encounters. Secondary outcomes include patient-reported outcomes (ie, quality of life, evaluated with the 5-level EQ-5D knowledge confidence health behavior and self-management) and clinical outcomes (ie, symptom burden, evaluated with the Palliative care Outcome Scale–Renal nutritional status, evaluated with the Patient-Generated Subjective Global Assessment and intradialytic weight gain). App engagement will be determined via app analytics. All analyses will be undertaken using an intention-to-treat approach comparing the intervention and usual care arms. The study has been approved by Nepean Blue Mountains Human Research Ethics Committee (2020/ETH00910) and recruitment has begun at nine sites. We expect to finalize data collection by 2023 and publish the manuscript by 2024. Enhancing health literacy skills for patients undergoing hemodialysis is an important endeavor, given the association between poor health literacy and poor health outcomes, especially among culturally erse groups. The findings from this trial will be published in peer-reviewed journals and disseminated at conferences, and updates will be shared with partners, including participating local health districts, Kidney Health Australia, and consumers. The SUCCESS app will continue to be available to all participants following trial completion. Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000235808 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380754& isReview=true DERR1-10.2196/39909
Publisher: Springer Science and Business Media LLC
Date: 23-10-2017
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1053/J.JRN.2019.05.003
Abstract: The objective of this study is to document the patterns of usage regarding intradialytic parenteral nutrition (IDPN) within in-center hemodialysis units in Australia. This study used purposive non-probabilistic s ling to obtain details of the proportion of units using IDPN formulations used infusion rates and barriers and enablers to usage. All participants were practicing renal dietitians in Australia. The participants were recruited from professional nephrology networks and completed a cross-sectional self-administered online survey. A total of 68 responses were received, representing 41% of dialysis units in Australia. Half did not use IDPN at all, and one-third (38.2%) used it regularly. The most common IDPN formulations used were triple phase bags (48.3%) and lipid-only infusions (22.6%). Variation in practice was seen regarding maximum infusion rates for some formulations. Costs for IDPN were borne by dialysis units (74%) or pharmacy (16%). Barriers to the use of IDPN included bureaucratic hurdles and misconceptions about IDPN as an effective form of nutrition support. The presence of a protocol, support from medical and other staff, and dietitian experience were enablers to the use IDPN. IDPN use in Australia is not uncommon. This survey extends the small evidence base about the practice of IDPN and identified some important variations in practice. Some barriers to IDPN use could be overcome with further training to support staff. Enablers to IDPN use include protocols with defined responsibilities and access to experienced clinicians.
Publisher: Wiley
Date: 27-11-2019
DOI: 10.1111/NEP.13680
Abstract: Obesity is increasingly common in in iduals with chronic kidney disease (CKD). Being overweight or obese is associated with both the development and progression of kidney disease. Lifestyle interventions such as the use of very low-calorie diets (VLCD) are being used increasingly for patients with CKD despite warnings from manufacturers that they should be avoided or used with caution. Whilst these diets are effective and can induce rapid weight loss and suppress appetite, their use in patients with chronic and end stage kidney disease is more complex than in the general population. VLCD use in adults with kidney disease requires a more nuanced approach to prescription and closer monitoring for unintended side effects. This review describes the indications and clinical management of patients with CKD undertaking a very low-calorie diet and provides practical guidance regarding how to manage a VLCD, particularly for the latter stages of CKD.
Publisher: Wiley
Date: 19-10-2018
Abstract: To validate the polyunsaturated food frequency questionnaire (PUFA FFQ) and test for reproducibility in people with end stage renal disease on dialysis treatment. Participants (n = 32) completed the PUFA FFQ and three 24-hour recalls. Erythrocyte s les (n = 29) were used for erythrocyte fatty acid analysis. The triangular relationship between the PUFA FFQ, 24-hour recalls and the biomarker was assessed using the method of triads. Agreement between the two dietary methods was also assessed using Bland-Altman plots and classification by quintiles. Reproducibility was tested on a subset of the group (n = 8). The PUFA FFQ was a valid measure of all PUFA except for docosapentaenoic acid (DPA) and arachidonic acid (AA). Strong validity coefficients were found for n-3 long-chain PUFA (LCPUFA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) of 0.914 (95% CI: 0.665, 0.997) and 0.889 (95% CI: 0.706, 0.994), respectively. In the Bland-Altman plots 91-100% of observations fell between the limits of agreement for all PUFA. There were significant correlations between the initial FFQ and the repeat FFQ for all PUFA except DPA and AA. The PUFA FFQ is a valid tool for assessing PUFA intake in people with end stage renal disease.
Publisher: Wiley
Date: 03-10-2014
Publisher: American Diabetes Association
Date: 10-05-2016
DOI: 10.2337/DC16-0451
Abstract: To determine the effect of different seasons on the prevalence of gestational diabetes mellitus (GDM) by using World Health Organization criteria. The results of all pregnancy glucose tolerance tests (GTTs) were prospectively collected over a 3-year period in a temperate climate, and the results were grouped by season. The results of 7,369 pregnancy GTTs were available for consideration. In winter, the median 1-h and 2-h glucose results after GTT were significantly (P & 0.0001) lower than the overall 1-h and 2-h results. The prevalence of GDM at the 1-h diagnostic level was 29% higher in summer and 27% lower in winter than the overall prevalence (P = 0.02). The prevalence of GDM at the 2-h diagnostic level was 28% higher in summer and 31% lower in winter than the overall prevalence (P = 0.01). The prevalence of GDM varies according to seasons, which leads to the possible overdiagnosis of GDM in summer and/or underdiagnosis in winter. Further research into standardization of the GTT or seasonal adjustment of the results may need to be considered.
Publisher: Wiley
Date: 22-05-2017
DOI: 10.1111/JHN.12478
Abstract: Governing organisations for health services currently recommend a patient-centred (PC) approach to practice for all health professions, including dietetics. For the vulnerable older malnourished patient, this approach needs to be prioritised to improve outcomes. The paucity of patient experience data likely limits evidence-based, patient-centred care (PCC) from being implemented effectively. The present study aimed to identify quality indicators of dietetic services from the perspectives of older malnourished patients to inform evidence-based PC dietetic care. Surveys were completed by a s le of 28 females and 28 males (mean age 81 years) who had been seen by a dietitian for malnutrition assessment. In-depth, face-to-face, semi-structured interviews were undertaken with a sub-s le of four females and six males (mean age 81 years). Interviews were transcribed verbatim. Thematic analysis of transcripts and open-ended survey responses was conducted to determine patient-identified quality indicators. Three structure indicators (continuity of care through regular contact and post-discharge dietetic follow-up interdisciplinary coordination and collaboration and high-quality hospital food services), five process indicators (addressing a patient's primary medical concern involving the patient's family providing clear and simple dietetic information providing expert dietary knowledge utilising interpersonal communication skills) and three outcome indicators (improvement in health status improvement or maintenance of independence weight gain) were identified. The experiences of older malnourished patients with dietetic services, as described in the present study, reinforce the importance of ensuring high-quality and tailored dietetic care as a key element of PC dietetic services. The quality indicators of dietetic services identified in the present study may facilitate dietitians to provide evidence-based PCC for older malnourished patients.
Publisher: Wiley
Date: 10-07-2023
DOI: 10.1111/JHN.13204
Abstract: Immediate action is needed to stabilise the climate. Dietitians require knowledge of how the therapeutic diets they prescribe may contribute to climate change. No previous research has quantified the climate footprint of therapeutic diets. This study sought to quantify and compare the climate footprint of two types of therapeutic diets for people with chronic kidney disease (CKD) with two reference diets. A usual diet for an in idual with CKD and a novel plant‐based diet for CKD were compared with the current Australian diet and the Australian‐adapted EAT Lancet Planetary Health Diet (PHD). The climate footprint of these diets was measured using the Global Warming Potential (GWP*) metric for a reference 71‐year‐old male. No diets analysed were climate neutral, and therefore, all contribute to climate change. The novel plant‐based diet for CKD (1.20 kg carbon dioxide equivalents [CO 2 e] per day) produced 35% less CO 2 e than the usual renal diet for an in idual with CKD (1.83 kg CO 2 e per day) and 50% less than the current Australian diet (2.38 kg CO 2 e per day). The Australian‐adapted EAT Lancet PHD (1.04 kg CO 2 e per day) produced the least amount of CO 2 e and 56% less than the current Australian diet. The largest contributors to the climate footprint of all four diets were foods from the meats and alternatives, dairy and alternatives and discretionary food groups. Dietetic advice to reduce the climate footprint of therapeutic diets for CKD should focus on discretionary foods and some animal‐based products. Future research is needed on other therapeutic diets.
Publisher: Wiley
Date: 24-09-2018
DOI: 10.1111/NEP.13118
Abstract: The aim of the present study was to develop a consensus report to guide dietetic management of overweight or obese in iduals with chronic kidney disease (CKD). Six statements relating to weight management in CKD guided a comprehensive review of the literature. A summary of the evidence was then presented at the renal nutrition meeting of the 2016 Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology. Majority agreement was defined as group agreement on a statement of between 50-74%, and consensus was considered ≥75% agreement. The recommendations were developed via a mini Delphi process. Two statements achieved group consensus: the current guidelines used by dietitians to estimate energy requirements for overweight and obese people with CKD are not relevant and weight loss medications may be unsafe or ineffective in isolation for those with CKD. One statement achieved group agreement: Meal replacement formulas are safe and efficacious in those with CKD. No agreement was achieved on the statements of whether there is strong evidence of benefit for weight loss prior to kidney transplantation whether traditional weight loss strategies can be used in those with CKD and if bariatric surgery in those with end stage kidney disease is feasible and effective. There is a limited evidence base to guide the dietetic management of overweight and obese in iduals with CKD. Medical or surgical strategies to facilitate weight loss are not recommended in isolation and require a multidisciplinary approach with the involvement of a skilled renal dietitian.
Publisher: Elsevier BV
Date: 05-2023
DOI: 10.1053/J.JRN.2022.10.006
Abstract: To describe the quality and health literacy demand of publicly available diet related videos on YouTube for people with Polycystic Kidney Disease (PKD). This desk-based content analysed involved a comprehensive search of YouTube using key words relating to the dietary management of people with PKD. The health literacy demand was evaluated using the Patient Education Material Assessment Tool (PEMAT) for audio-visual materials. A PEMAT score of >70% is indicative of videos that are understandable and actionable. A total of 15 videos were evaluated (median 1.28 minutes duration (range: 55 seconds to 81 minutes). The majority were produced by reputable sources (such as a PKD related charity (n= 12) or Nephrologist (n= 2). The quality of the videos was high with the majority (14/15) providing evidence-based advice. The understandability and actionability of the videos were considered low (median PEMAT score 67% (IQR: 51.4-81.7) and 66.83 % (IQR: 50-67) respectively. There has been a small increase in the number of diet related videos for people with PKD in the past five years. The majority provide evidence-based information, which is also a substantial improvement since the last analysis in 2015. Unfortunately, the health literacy demand of these resources remains suboptimal, and future work should be directed to improving the understandability and actionability of videos.
Publisher: Elsevier BV
Date: 2023
DOI: 10.1053/J.JRN.2022.06.005
Abstract: The aim of this study is to quantify the readability, actionability, understandability, and overall quality of dietary education resources designed for patients and published in the Journal of Renal Nutrition. All patient education materials published in the "Patient Education" section of the journal from 2011 to 2021 were included. The readability, health literacy demand, and quality were evaluated using the Hemingway editor, Patient Education Materials Assessment Tool, and the Centers for Disease Control and Prevention Clear Communication Index (CDC CCI) respectively. Good quality materials were those with a reading grade level of ≤8 a Patient Education Materials Assessment Tool score of >70% (indicating materials were understandable and actionable), and a CDC CCI score >90%. A total of 42 resources were evaluated. Most materials (92%) were written at an appropriate level of readability (median grade 5, interquartile range [IQR: 5-7). The median understandability score was 71% (IQR: 60-81) however, only half (52%) of the materials met the 70% benchmark. Materials published performed poorly for actionability with the median actionability score of 37% (IQR: 20-83), and only 29% met the benchmark score. Overall quality was scored as low, with a median CDC CCI score of 65%, and only 10% of materials met the benchmark score. Areas for improvement were identified including providing a clear purpose, and summary of important points, explaining numbers and how to perform calculations, and including at least one action to take. Future efforts to improve actionability need to use the active voice, directly address readers, explain how to act, and describe the steps required. Patient education materials that are attentive to health literacy principles beyond readability may enhance patient engagement, confidence, and empowerment, and improve adherence to the kidney diet.
Publisher: Wiley
Date: 26-04-2016
DOI: 10.1111/JORC.12157
Abstract: For people on peritoneal dialysis (PD), constipation is associated with technique failure. For those on haemodialysis (HD), constipation has been associated with a reduction in quality of life. The objectives of this study were to (i) determine the prevalence of functional constipation (ii) compare patient perception of constipation with Rome III criteria for functional constipation (iii) describe the prevalence of constipation and stool form using Bristol Stool Form Scale (BSFS) (iv) determine differences in bowel habit and stool form between those on dialysis compared to pre-dialysis and (v) determine the diagnostic accuracy of self-perception and the Rome III criteria against the BSFS. A cross-sectional group of pre-dialysis (eGFR < 15 ml/min) and dialysis patients were recruited. A total of 148 patients participated (98 HD, 21 PD and 21 pre-dialysis). completed a questionnaire consisting of self-perception of the presence of constipation, simplified questions from the Rome III criteria for functional constipation, scored their stool form using the BSFS and reported laxative use. The prevalence of constipation using the Rome III criteria was 12.3% patient perception 46.3% and 25.7% using the BSFS. Prevalence differed according to the tool used. No single method alone is sufficient for accurately determining if a patient is constipated. Relying on patients' self-perception may be unreliable. Ideally patient assessment of constipation should incorporate both the Rome III criteria and BSFS in a method such as the one designed as a result of this research. Further research is needed to assess its usability and practicality in clinical practice.
Publisher: Wiley
Date: 11-04-2019
DOI: 10.1111/ANS.15085
Abstract: Evidence about the impact of obesity on surgical resource consumption in the Australian setting is equivocal. Our objectives were to quantify the prevalence of obesity in four frequently performed surgical procedures and explore the association between body mass index (BMI) and hospital resource utilization including procedural duration, length of stay (LOS) and costs. A retrospective cohort study of patients undergoing four surgical procedures at a tertiary referral centre in New South Wales, between 1 January 2016 and 31 December 2016, was conducted. The four surgical procedures were total hip replacement, laparoscopic appendectomy, laparoscopic cholecystectomy and hysteroscopy with dilatation and curettage. Surgical groups were stratified according to BMI category. A total of 699 patients were included in the study. The prevalence of obesity was significantly higher than local and national population estimates for all procedures except appendectomy. BMI was not associated with increased hospital resource utilization (procedural, anaesthetic or intensive care stay duration) in any of the four surgical procedures examined after controlling for age, gender and complexity. For other outcomes of hospital resource utilization (LOS and cost), the relationship was inconsistent across the four procedures examined. A high BMI was positively associated with higher LOS, medical costs and allied health costs in those who underwent an appendectomy, and critical care costs in those who underwent laparoscopic cholecystectomy. Obesity was common in patients undergoing four frequently performed surgical procedures. The relationship between BMI and hospital resource utilization appears to be complex and varies across the four procedures examined.
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1053/J.JRN.2017.06.007
Abstract: Mobile phone applications (apps) are increasingly being used by patients with chronic kidney disease (CKD). We sought to describe the main purpose of commonly available renal diet apps and to quantify the accuracy of information, technical quality, and health literacy demand of renal diet apps. The design was content analysis. All eligible renal diet apps in the Australian Apple App Store, Google Play, Windows Phone, and Blackberry App World were evaluated. Eligible apps were in English and were related to kidney disease in humans (of any type or stage). Exclusion criteria included apps which were prohibited because of password protection. Renal diet information in the apps was compared with evidence-based guidelines for the management of kidney disease to quantify information accuracy. App information was evaluated using the Silberg Scale. Technical quality and health literacy demand were evaluated using the Mobile Application Rating Scale. A total of 21 apps were eligible for evaluation. The main purpose of these apps was to provide food and nutrition information (57.1%) or for educative purposes for CKD patients (38.1%). Only 47.6% (10/21) of apps contained accurate evidence-based information. Overall, app technical quality was considered acceptable (mean Mobile Application Rating Scale score 3.19 ± 0.35 out of 5), with 80.9% of apps scoring acceptable or greater for app technical quality. Scores for health literacy demand also indicated that most apps (15/21, 71.4%) were acceptable. A range of apps currently exist that may provide in iduals with CKD with useful food and nutrition information or increase their knowledge of the renal diet. These apps are also mainly of acceptable technical quality and health literacy demand. However, caution is required when using renal diet apps because more than half of the apps evaluated were not accurate and evidence based.
Publisher: Wiley
Date: 13-08-2020
DOI: 10.1111/NEP.13639
Abstract: A multidisciplinary approach, including dietetics, is considered the optimal model of care for dialysis preparation. Dietetic consultation (DC) focuses on symptom management and dietary changes to delay time to dialysis. Evidence of the effectiveness of DC on time to dialysis is limited. This study aimed to investigate the impact of DC on time to dialysis for patients attending a pre-dialysis clinic. A retrospective cohort study was designed to include all patients attending outpatient pre-dialysis clinics at a large metropolitan renal service between January 2014 and March 2018. Time to dialysis (days) was compared between patients that received DC and those who did not. Cox proportional hazards analysis allowing for adjustment of differences and confounders was undertaken. A cohort of 246 patients was identified. Median estimated glomerular filtration rate was 16mL/min per 1.73 m DC provided to patients attending a pre-dialysis clinic was associated with a delayed time to dialysis. Standardised referral pathways to improve patient access to renal dietetic services are recommended to optimise care.
Publisher: Elsevier BV
Date: 05-2023
DOI: 10.1053/J.JRN.2022.06.004
Abstract: To describe nutrition impact symptom clusters present in a large s le of Indigenous hemodialysis patients. This study was a cross sectional secondary analysis of data from a service audit conducted in 2016. All participants were hemodialysis patients from two satellite hemodialysis units in Central Australia. All participants completed a Patient Generated Subjective Global Assessment. Exploratory Factor Analysis was performed to identify nutrition impact symptom clusters. A total of 249 patients were included, representing 16 % of all Indigenous dialysis patients in Australia. Malnutrition was present in 29% of the s le. Five distinct nutrition impact symptom clusters were identified, accounting for 51.942% of the variance in symptoms. The five clusters extracted were: sore mouth (swallow problems, sore mouth, pain) nausea and vomiting (nausea, vomiting, taste changes) abnormal bowels (diarrhoea, constipation, depression) anorexia (no appetite, early satiety) dry mouth (dry mouth, dental problems). Malnourished patients experienced a significantly greater symptom burden in this study. This analysis extends the small evidence base about the nutrition impact symptom burden of Indigenous hemodialysis patients. Understanding symptom clusters and how symptoms are connected may be useful for triaging care and managing malnutrition.
Publisher: S. Karger AG
Date: 2018
DOI: 10.1159/000485735
Abstract: Hemorrhagic cystitis (HC) is a serious complication after hematopoietic stem cell transplantation (HSCT). Stromal cells have been tested as therapy for HC. Decidua stromal cells (DSCs) protect the fetus from the mother's immune system. Eleven patients with HC of grades 3-4 were treated with DSCs after HSCT. The median age was 33 years (range 8-50), and the median dose of DSCs was 1.5 × 106/kg (range 0.7-2.5). The patients were given 1 dose (1-4). In 5 patients, HC disappeared within 5 days after DSC infusion. Patients who received DSCs within 3 days after the start of HC had a duration of HC of 5 days and a shorter duration of pain than patients who were given DSCs later (p = 0.02). Three patients received DSCs prepared in albumin instead of AB-plasma and tended to have a shorter duration of pain (p = 0.07). There was no infusion toxicity. Adverse events were those often seen after HSCT. Nine of the 11 patients (82%) were alive 1 year after HSCT. Based on this pilot study, we started a randomized, placebo-controlled double-blind study using 2 doses of 1 × 106 DSCs/kg suspended in albumin for treatment of early HC.
No related grants have been discovered for Kelly Lambert.