28 research outputs found
Storytelling, women's authority and the 'Old-Wife's Tale': 'The Story of the Bottle of Medicine'
No full textThe focus of this article is a single personal narrative – a Shetland woman’s telling of a story about two girls on a journey to fetch a cure for a sick relative from a wise woman. The story is treated as a cultural document which offers the historian a conduit to a past that is respectful of indigenous woman-centred interpretations of how that past was experienced and understood. The ‘story of the bottle of medicine’ is more than a skilful telling of a local tale; it is a memory practice that provides a path to a deeper and more nuanced understanding of a culture. Applying perspectives from anthropology, oral history and narrative analysis, three sets of questions are addressed: the issue of authenticity; the significance of the narrative structure and storytelling strategies employed; and the nature of the female performance. Ultimately the article asks what this story can tell us about women’s interpretation of their own history
New insights into cancer-related skeletal muscle depletion and malnutrition in patients with head and neck cancer
No full textMalnutrition is prevalent in patients with head and neck cancer (HNC) impacting negatively on clinical, economic and patient-centred outcomes. As diagnostic assessment and phenotypic criteria of malnutrition should include evaluation of muscle mass, body composition analysis by computed tomography (CT) has become a focus of cancer research arising from its well-documented prognostic significance. Positioned within the American Academy of Nutrition and Dietetics (AND) Nutrition Care Process (NCP) Model, this thesis aimed to examine the impact of CT-defined skeletal muscle depletion on outcomes for adult patients (≥18 years) who had completed radiotherapy ± other treatment modality of curative intent for HNC. Key findings include: i) both skeletal muscle depletion and malnutrition impact negatively on outcomes and therefore hold important prognostic value for patients with HNC; ii) human body composition is complex, influencing individualised risk in an era of personalised medicine; iii) methodological consensus and reporting guidelines in CT-defined skeletal muscle research are required; and iv) the clinical utility of CT-defined skeletal muscle depletion warrants further exploration. The powerful prognostic value of nutritional status reinforces the importance of comprehensive nutrition assessment using validated tools in the oncology population, aligning with current evidence-based guidelines. This thesis substantially advances the knowledge and understanding of the impact of CT-defined skeletal muscle depletion and nutritional status on outcomes for patients with HNC. The overall findings highlight that adhering to evidence-based guidelines for optimum cancer nutrition care plays a central role in the identification of patients at high risk of poor outcomes. This research holds important implications for clinical care, education, research and policy in which dietitians are ideally placed to take a leadership role to improve outcomes for this complex patient group
Best evidence to best practice: Implementing an innovative model of care for nutritional management of patients with head and neck cancer
No full textThis project aims to implement and evaluate an innovative best-practice dietetic model of care (MOC) based on published Evidence Based Guidelines for Nutritional Management of Patients with Head and Neck Cancer. Through integration with the multidisciplinary team, the MOC will take a patient-centred approach to delivery of nutritional care to minimise the detrimental sequelae of malnutrition and improve outcomes in this complex patient group.$172,911.00Translating Research into Practice Fellowship
Nutritional status and skeletal muscle status in patients with head and neck cancer: Impact on outcomes
No full textAbstract Background Computed tomography (CT)‐defined skeletal muscle depletion and malnutrition are demonstrated as poor prognostic factors in patients with head and neck cancer (HNC), however to date, have only been explored in isolation. We aimed to describe body composition profile and examine the impact of nutritional status as well as independently and concurrently occurring body composition features on overall survival, treatment completion, unplanned admissions and length of stay (LOS) in patients undergoing radiotherapy (RT) or chemoradiotherapy (CRT) of curative intent for HNC. Methods This work is a retrospective, observational study of patients who had completed treatment of curative intent for HNC. Scored Patient‐Generated Subjective Global Assessment (PG‐SGA) was used to determine nutritional status. Tissue‐density data were derived at the third lumbar vertebra (L3) with sarcopenia and myosteatosis defined by published, sex‐specific threshold values stratified by body mass index for skeletal muscle index (cm2/m2) and skeletal muscle radiodensity (SMR, Hounsfield Unit). Results Pre‐treatment data (n = 277: 78% male, mean (SD) age 60 (13) years) revealed the prevalence of malnutrition (24.9%), sarcopenia (52.3%), myosteatosis (82.3%), and concurrently occurring sarcopenia and myosteatosis (39.7%). Malnutrition was independently associated with reduced OS for patients with moderate [hazard ratio (HR) 2.57; 95% confidence interval (CI) 1.45–4.55, P = 0.001] and severe (HR 3.19; 95% CI 1.44–7.07, P = 0.004) malnutrition on multivariable analysis but not sarcopenia (HR 1.09; 95% CI 0.70–1.71), P = 0.700 or myosteatosis (HR 1.28; 95% CI 0.57–2.84), P = 0.500). Malnutrition was associated with treatment discontinuation (P < 0.001), not completing RT as planned (P < 0.001), unplanned hospital admission (P = 0.021), and greater LOS (P < 0.001). Skeletal muscle status features were associated with unplanned hospital admissions for those with no features (32%), with sarcopenia only (50%), myosteatosis only (25%), and concurrent sarcopenia and myosteatosis (50%), P < 0.001. Similarly, a clinically relevant greater median (Q1, Q3) LOS was observed for those with sarcopenia only [5 (3, 32)], myosteatosis only [10 (5, 30)], concurrent sarcopenia, and myosteatosis [14 (4, 33)] days vs. those with no features [3 (2, 11)] days, P = 0.2. Conclusions Malnutrition was a more powerful prognostic indicator than CT‐defined skeletal muscle depletion and was independently associated with reduced OS in patients undergoing RT or CRT of curative intent for HNC. CT‐defined skeletal muscle depletion studies should recognize the multifaceted nature of human body composition and also measure nutritional status using validated methods in order to move towards developing a typology of high risk criteria for this complex patient group
Optimal frequency of individualised nutrition counselling in patients with head and neck cancer receiving radiotherapy: A systematic review
No full textIs sarcopenia a predictor of prognosis for patients undergoing radiotherapy for head and neck cancer? A meta-analysis
No full textIntroduction: Computed tomography (CT)-defined sarcopenia is a demonstrated poor prognostic factor for survival in patients with cancer, however, its impact in patients with head and neck cancer (HNC) has only recently been explored. This study aimed to determine the prognostic impact of CT-defined sarcopenia at the level of the third lumbar vertebra (L3) on overall survival in patients with HNC undergoing radiotherapy ± other treatment modality of curative intent. Methods: A systematic review of the literature published between January 2004 and May 2020 was conducted in Medline, Embase, CINAHL, AMED and PubMed. Empirical studies in adults (≥18 years) who had completed radiotherapy of curative intent ± other treatment modalities that evaluated sarcopenia using the gold standard method at L3 and applied sex-specific cut-offs were included. Outcome of interest was overall survival. Study quality was assessed using the Quality In Prognosis Studies (QUIPS) tool. Hazard ratios with 95% confidence intervals derived from multivariate analysis were extracted directly from studies. Random-effects meta-analysis was used to determine the pooled hazard ratio for overall survival in patients with sarcopenia versus those without using RevMan (Version 5.3). The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Results: A total of 6211 studies were identified and screened from which seven studies met the inclusion criteria with 1059 pooled patients. All studies defined sarcopenia as low muscle mass but varied in skeletal muscle index (SMI) threshold values applied and ethnicity. Sarcopenia prevalence ranged from 6.6 to 64.6% pre-treatment and 12.4 to 65.8% post-treatment. Pre-treatment sarcopenia was associated with reduced overall survival (HR 2.07; 95%CI, 1.47–2.92, p < 0.0001, I = 49%) with similar findings for post-treatment sarcopenia (HR 2.93; 95%CI, 2.00–4.29, p < 0.00001, I = 0%) with moderate to low heterogeneity exhibited amongst studies respectively. The certainty of evidence for overall survival according to GRADE was low for pre-treatment sarcopenia and moderate for post-treatment sarcopenia. Conclusions: CT-defined sarcopenia is independently associated with reduced overall survival in patients with HNC and holds a clinically meaningful prognostic value. Consensus regarding sarcopenia assessment and definitions is warranted in order to substantiate these findings and support implementation of body composition assessment as a clinically meaningful prognostic tool into practice
New Zealand breakfast cereals: are there sufficient low-sugar, low-sodium options?
No full textWe wish to respond to a letter by Gina Levy of Kellogg (Australia) Pty Ltd – Research and Technology, Australia entitled ‘The New Zealand breakfast cereal category is dynamic and responsive to consumer preferences’, published in Public Health Nutrition⁽¹⁾ in response to our published article ‘The nutritional quality of New Zealand breakfast cereals: an update’⁽²⁾. We thank the author for her interest in our publication and will respond to several of her comment
Australian cancer clinicians' awareness, understanding and perceptions regarding cancer-related malnutrition and sarcopenia
No full textBackground : Cancer‐related malnutrition and sarcopenia (low muscle mass and strength) are independently associated with reduced survival, increased treatment toxicities and poorer function. International evidence‐based guidelines exist to guide nutrition screening and interventions. However, despite the severe consequences, little is known about Australian cancer clinicians’ awareness of these conditions and practices relating to their identification and management. This study aimed to determine clinician awareness, understanding and perceptions of malnutrition and sarcopenia in people with cancer.Methods : A cross‐sectional survey of Australian cancer clinicians was undertaken between November 2018 and January 2019. The 30‐item online survey was circulated through professional organisations and health services.Results : The 111 participants represented dietetic (38%), nursing (34%), medical (14%) and allied health (14%) clinicians. Overall, 86% and 88% clinicians were aware of accepted definitions of malnutrition and sarcopenia, respectively, with 89% agreeing these were extremely or very important conditions in the overall management of people with cancer. However, perception of responsibility for identification of these conditions varied considerably. Further, 21% and 43% of clinicians had limited or no confidence in their ability to identify malnutrition and sarcopenia, respectively. Greatest barriers to identification and management of malnutrition were access to tools or skills required and lack of services to manage malnourished patients. Greatest barriers to identification and management of sarcopenia were lack of confidence and lack of services to manage patients with sarcopenia.Conclusions : Awareness of cancer‐related malnutrition and sarcopenia are high among Australian cancer clinicians. The identification and management of these conditions is limited by variation in perceived responsibility, lack of confidence and insufficient services to manage patients with malnutrition or sarcopenia. Work at a national level is required to support cancer clinicians and health services implement optimal nutrition care for people with cancer‐related malnutrition and sarcopenia
PTBP1 and PTBP2 Repress Nonconserved Cryptic Exons
No full textSummaryThe fidelity of RNA splicing is maintained by a network of factors, but the molecular mechanisms that govern this process have yet to be fully elucidated. We previously found that TDP-43, an RNA-binding protein implicated in neurodegenerative disease, utilizes UG microsatellites to repress nonconserved cryptic exons and prevent their incorporation into mRNA. Here, we report that two well-characterized splicing factors, polypyrimidine tract-binding protein 1 (PTBP1) and polypyrimidine tract-binding protein 2 (PTBP2), are also nonconserved cryptic exon repressors. In contrast to TDP-43, PTBP1 and PTBP2 utilize CU microsatellites to repress both conserved tissue-specific exons and nonconserved cryptic exons. Analysis of these conserved splicing events suggests that PTBP1 and PTBP2 repression is titrated to generate the transcriptome diversity required for neuronal differentiation. We establish that PTBP1 and PTBP2 are members of a family of cryptic exon repressors
PUB028 Implementation and Evaluation of a Lung Cancer Multidisciplinary Team (MDT) Communication Tool for General Practitioners (GPs)
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