77 research outputs found
Creatinine index: a retrospective cohort study in an urban Australian dialysis context
No full textAim: This study aimed to described the relationship between the CI and mortality in an Australian context. Introduction: Maintenance haemodialysis is a catabolic state associated with a significant decrease in lean body mass (LBM) and protein energy wasting. LBM can be derived or estimated from creatinine kinetic modelling, specifically the creatinine index (CI). This has been demonstrated in cohort studies to predict mortality. Methods: One hundred seventy-nine patients undergoing haemodialysis in 2015 were included in this cohort. They were followed for 5 years with pertinent clinical data collected to calculate the CI as of December 2015. For analysis, patients were split into a high and low CI group based on the median (18.32 mg/kg/day). The primary outcome of interest was all-cause mortality, and secondary outcomes included myocardial infarction, stroke and transplantation. Results: During follow-up, 69 (76.7%) patients in the low CI group and 28 (31.5%) patients in the high CI group died (P < 0.001). The relative risk (RR) of mortality within the low compared with the high CI group was 2.43 (95% confidence interval, 1.75–3.38). Fully adjusted Cox proportional hazards modelling demonstrated a hazard ratio (HR) of 0.498 (95% CI, 0.292–0.848) for survival in the high CI group. Lower CI was associated with increased risk of stroke (RR, 5.43 [95% CI, 1.24–23.84]), whereas transplant was more likely in the high CI group (RR, 6.4 [95% confidence interval, 1.96–20.88]). Conclusions: In a single-centre Australian haemodialysis cohort, the CI was strongly associated with mortality and stroke risk. The CI is an accurate and simple method to identify patients with low LBM at risk for significant morbidity and mortality.Full Tex
Obesity as a barrier to kidney transplantation: Time to eliminate the body weight bias?
No full textThere is clear evidence that survival rates following transplantation far exceed those for remaining on dialysis, regardless of body size measured by body mass index (BMI). Studies over the past 15 years also suggest little to no difference in long-term outcomes, including graft survival and mortality, irrespective of BMI, in contrast to earlier evidence. However, weight bias still exists, as access to kidney transplantation remains inequitable in centers using arbitrary BMI limits. Clinicians faced with the decision regarding listing based on body size are not helped by conflicting recommendations in national and international guidelines. Therefore, in clinical practice, obesity, and recommendations for weight loss, remain a controversial issue when assessing suitability for kidney transplantation. Obesity management interventions in end-stage kidney disease (ESKD), whether for weight loss for transplantation listing or for slowing kidney disease progression, are under-explored in trial settings. Bariatric surgery is the most successful treatment for obesity, but carries increased risk in the ESKD population, and the desired outcome of kidney transplant listing is not guaranteed. Centers that limit transplants to those meeting arbitrary levels of body mass, rather than adopting an individualized assessment approach, may be unfairly depriving many ESKD patients of the survival and quality of life benefits derived from kidney transplantation. However, robotic kidney transplantation surgery holds promise for reducing perioperative risks related to obesity, and may therefore represent an opportunity to remove listing criteria based on size.</p
Profile of author and Portland native Heidi Julavits, featuring an interview in
No full textProfile of author and Portland native Heidi Julavits, featuring an interview in question-and-answer format. Julavits\u27s third novel, The Uses of Enchantment, is about a 17-year-old girl in West Salem, Mass., who may or may not have faked her own abduction. In addition to fiction writing, Julavits is founding editor of the Believer magazine. Julavits splits her time between Manhattan and Brooklin, Maine
Impacts of Agritourism on Social Capital during the COVID-19 Pandemic in Rural Ontario
No full textThis thesis examines the use of agritourism as a venue for events during the COVID-19 pandemic and how it interacts with social capital of agritourists and agritourism operators. The literature on the relationship of agritourism, social capital and the COVID-19 pandemic is still developing. This research uses an exploratory approach with elements from grounded theory to develop an understanding of how agritourism, social capital, and the COVID-19 pandemic interact. A mixed-method approach was used to gain insights from agritourism operators and agritourists. Semi-structured interviews were conducted with operators of agritourism businesses and eSurveys were distributed online to people who had attended or hosted an event at an agritourism venue. There were disruptions to the operations of agritourism businesses; however, this led to opportunities to further develop their business practices. Agritourists expressed that agritourism venues were great spaces to host events; however, the pandemic had little to no influence on attendance
Standardised Outcome Reporting for the Nutrition Management of Complex Chronic Disease: A Rapid Review
No full textIndividuals with coexisting chronic diseases or with complex chronic disease are among the most challenging and costly patients to treat, placing a growing demand on healthcare systems. Recommending effective treatments, including nutrition interventions, relies on standardised outcome reporting from randomised controlled trials (RCTs) to enable data synthesis. This rapid review sought to determine how the scope and consistency of the outcomes reported by RCTs investigating nutrition interventions for the management of complex chronic disease compared to what is recommended by the core outcome sets (COS) for individual disease states. Peer-reviewed RCTs published between January 2010 and July 2020 were systematically sourced from PubMed, CINAHL and Embase, and COS were sourced from the International Consortium for Health Outcomes Measurements (ICHOM) and the Core Outcome Measures in Effectiveness Trials (COMET) database. A total of 45 RCTs (43 studies) and 7 COS were identified. Outcomes were extracted from both the RCTs and COS and were organised using COMET Taxonomy Core Areas. A total of 66 outcomes and 439 outcome measures were reported by the RCTs. The RCTs demonstrated extensive outcome heterogeneity, with only five outcomes (5/66, 8%) being reported with relative consistency (cited by ≥50% of publications). Furthermore, the scope of the outcomes reported by studies was limited, with a notable paucity of patient-reported outcomes. Poor agreement (25%) was observed between the outcomes reported in the RCTs and those recommended by the COS. This review urges greater uptake of the existing COS and the development of a COS for complex chronic disease to be considered so that evidence can be better synthesised regarding effective nutrition interventions
Diet quality, Self-efficacy and Health Literacy in Adults with Chronic Kidney Disease: A Cross-Sectional Study
No full textObjective: Adherence to high-quality dietary patterns is associated with lower risk of disease progression and all-cause mortality in chronic kidney disease (CKD). Self-efficacy and health literacy are recognized as factors that may lead to better adherence to high-quality diets. However, these associations are not well studied in CKD. This study aims to explore the relationship between health literacy, self-efficacy, and diet quality in CKD. Methods: Participants with CKD stages 3a-5 recruited from 3 large tertiary hospitals were assessed using the Self-Efficacy for Managing Chronic Disease 6-item scale, the Health Literacy Questionnaire, and the Australian Eating Survey Food Frequency Questionnaire. Diet quality was measured using the Australian Recommended Food Score. Associations were examined using multivariable linear regression models, adjusted for sex and type 2 diabetes diagnosis. Results: Sixty participants were included in the analysis. Mean age of participants was 74.5 years and 58% were male. The mean Australian Recommended Food Score was poor (mean = 29.9 ± 9.1/73) and characterized by high intake of Processed foods and animal protein, and low intake of fruit and vegetables. Mean Self-Efficacy for Managing Chronic Disease 6-item scale was high (7.12 ± 2.07/10). Self-efficacy and health literacy domains 6 - Actively engage with healthcare providers and 7 - Navigating healthcare system independently predicted diet quality in the adjusted model for sex and type 2 diabetes. Conclusion: Adults with CKD report suboptimal diet quality. The results suggest that self-efficacy and aspects of health literacy should be considered when designing interventions aimed at improving diet quality in people with CKD.No Full Tex
Unintentional weight loss is an independent predictor of mortality in a hemodialysis population
No full textObjective: This study investigated common components of classification of nutrition screening risk in the prediction of clinical end-points (mortality and morbidity) in hemodialysis patients over a 3-year period (2005 to 2008). Design: This was a retrospective cohort study. Setting: This study was conducted at a Hemodialysis centre. Participants: The study included patients on maintenance hemodialysis in June 2005. Intervention: Assessment of nutrition risk was carried out using components of Protein-Energy Wasting criteria. Main Outcome Measure: Clinical outcome at the 3-year follow-up (June 2008) was measured as mortality and morbidity (as unplanned hospital admissions). Risk of mortality was investigated independent of comorbidities, age, gender, ethnicity, and dialysis vintage using Cox proportional hazards model. Results: A total of 217 patients met the inclusion criteria (143 male [66%]; age, 60.5 ± 15.6 years). Patients who lost ≥5% body weight in the 6 months before the study commenced, had a 3-fold (Hazard Ratio = 3.0; 95% confidence interval: 1.2 to 7.5) independent greater risk of death (P = .02). Low serum albumin
Carbohydrate Ingestion before Exercise for Individuals with McArdle Disease: Survey Evidence of Implementation and Perception in Real-World Settings
No full textIn individuals with McArdle disease (IWMD), the ingestion of carbohydrates before exercise has previously been shown in laboratory studies to significantly decrease the exercising symptoms of the condition and increase exercise tolerance during the early stages of exercise. As a result, carbohydrate ingestion pre-exercise is currently included in management guidelines, and often advised by medical professionals treating the condition. The aim of the current study was to determine whether positive lab-based results for the ingestion of carbohydrate before exercise in laboratory studies are being effectively translated into practice and produce perceptions of the same positive outcomes in real-world settings (RWS). An online survey method was used to collect responses from 108 IWMD. Data collected on the amount and type of carbohydrate consumed prior to exercise found that most surveyed participants (69.6%) who supplied qualitative data (n = 45) consumed less than the 37 g currently recommended in management guidelines. Survey data also revealed a large variation in the type and amount of carbohydrate ingested when IWMDs are applying carbohydrate ingestion before exercise in RWS. Consistent with these findings, only 17.5% of participants stated that they found carbohydrate ingestion before exercise relieved or minimised their MD symptoms. Results suggest that positive lab-based findings (increased exercise tolerance) of carbohydrate ingestion before exercise are not being effectively translated to RWS for many IWMD. There is a need for improved patient education of IWMD on the application of carbohydrate ingestion before exercise in RWS
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