Robert Denmark

Effect of Lactobacillus rhamnosus LGG® and Bifidobacterium animalis ssp. lactis BB-12® on health-related quality of life in college students affected by upper respiratory infections.

College students are susceptible to upper respiratory infections (URI) due to inadequate sleep, stress and close living quarters. Certain probiotic strains modulate immune function and may improve health-related quality of life (HRQL) during URI. The present study recruited apparently healthy college students and assessed the effect of probiotics on HRQL outcomes (i.e. self-reported duration, symptom severity and functional impairment of URI) in those who developed URI. Missed school and work days due to URI were also considered. Subjects (n 231) were apparently healthy college students living on campus in residence halls at the Framingham State University (Framingham, MA, USA), and were randomised to receive placebo (n 117) or probiotic-containing powder (daily dose of minimum 1 billion colony-forming units of each Lactobacillus rhamnosus LGG® (LGG®) and Bifidobacterium animalis ssp. lactis BB-12® (BB-12®); n 114) for 12 weeks. Subjects completed The Wisconsin Upper Respiratory Symptom Survey-21 to assess HRQL during URI. The final analyses included 198 subjects (placebo, n 97 and probiotics, n 101). The median duration of URI was significantly shorter by 2 d and median severity score was significantly lower by 34% with probiotics v. placebo (P,0·001), indicating a higher HRQL during URI. Number of missed work days was not different between groups (P=0·429); however, the probiotics group missed significantly fewer school days (mean difference = 0·2 d) compared to the placebo group (P=0·002). LGG® and BB-12® may be beneficial among college students with URI for mitigating decrements in HRQL. More research is warranted regarding mechanisms of action associated with these findings and the cost-benefit of prophylactic supplementation.

The impact of implementation of a nutrition support algorithm on nutrition care outcomes in an intensive care unit.

BACKGROUND A nutrition support algorithm is an operational version of a guideline that is adapted to local requirements and easy to apply in clinical practice. The purpose of this study was to determine the impact of implementing a nutrition support algorithm on nutrition care outcomes in an intensive care unit (ICU) in Switzerland without a designated dietitian. METHODS The retrospective study included data collection on 2 cohorts of critically ill patients before (n = 56) and after (n = 56) implementation of a nutrition support algorithm based on the guidelines published by the Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition guidelines. RESULTS There were significant differences between groups for the mean delivery of total energy in the pre- vs postimplementation group (909 ± 444 vs 1097 ± 420 kcal/d; P = .023) and mean delivery of protein per day (35 ± 17.9 vs 59.1 ± 27.3 g; P < .001). For patients staying at least 7 days in the ICU, the cumulative energy deficit decreased from -5664 ± 3613 kcal in the preimplementation group to -2972 ± 2420 kcal (P = .011) in the postimplementation group. No significant differences in the route of feeding and timing of enteral nutrition initiation were found. CONCLUSIONS Implementation of a nutrition support algorithm resulted in improved provision of energy and protein delivery. This may be further improved with routine nutrition assessment by a dietitian or a designated nutrition support team.

Workplace weight loss program; comparing live and internet methods.

Objective: To determine the effectiveness of the 12-week workplace intervention (WIP) on energy intake, weight, physical activity (PA) and cardiovascular disease (CVD) risk and the effect of delivery method on outcomes. Methods: A prospective clinical trial of a 12-week WIP comparing In-person and Internet-based delivery. All subjects received identical intervention with dietitian visits at baseline and weeks 6, 12 and 26. Subjects included overweight/obese academic health science center employees. Changes in weight, PA and CVD-risk were primary outcomes. Results: There was no significant treatment effect repeated-measure-ANOVA. Within subjects, significant main effects indicating improvement were noted at week-12 in weight, WC, body-fat, HRQOL and energy intake and at week-26 in weight, WC, body-fat, HRQOL, energy intake and systolic and diastolic BP. Conclusions: Improvements in some outcomes following a 12-week WIP were independent of delivery method.

The Effect of Medical Nutrition Therapy by a Registered Dietitian Nutritionist in Patients with Prediabetes Participating in a Randomized Controlled Clinical Research Trial

BACKGROUND Prior studies have provided evidence that lifestyle change prevents or delays the occurrence of type 2 diabetes mellitus. The challenge is to translate research evidence for type 2 diabetes mellitus prevention into health care settings. OBJECTIVE We investigated the effect of medical nutrition therapy (MNT) compared with usual care on fasting plasma glucose values, glycated hemoglobin (HbA1c), serum lipid levels, and Diabetes Risk Score, from baseline to the end of a 12-week intervention in overweight or obese adults with prediabetes. DESIGN Prospective, randomized, parallel group study of 76 adults with impaired fasting plasma glucose or an HbA1c of 5.7% to 6.4%, recruited between April 2010 and May 2011 who completed a 12-week intervention period. MAIN OUTCOME MEASURES The primary outcome measure was fasting plasma glucose. Secondary outcome measures were HbA1c, serum lipid levels, and Diabetes Risk Score. STATISTICAL ANALYSES A factorial repeated measures analysis of variance was used to make comparisons between the two groups (the MNT and usual care groups) and two measures of time (baseline and 12 weeks postintervention). Data analysis was performed using the Statistical Package for the Social Sciences (release 19.0, 2010, SPSS Inc). RESULTS There was a significant interaction for group assignment and HbA1c (P=0.01), with the MNT group experiencing significantly lower HbA1c levels than the usual care group (5.79% vs 6.01%) after the 12-week intervention. There was a significant interaction for group assignment and Diabetes Risk Score (P=0.001). Diabetes Risk Score for the MNT group decreased from 17.54±3.69 to 15.31±3.79 compared with the usual care group score, which went from 17.23±4.69 to 16.83±4.73. Regardless of group assignment, both groups experienced a reduction in total cholesterol (P=0.01) and low-density lipoprotein cholesterol (P=0.04) level. CONCLUSIONS The results demonstrate that individualized MNT is effective in decreasing HbA1c level in patients diagnosed with prediabetes.

Comparison of Dietary Intake Among Women on Maintenance Dialysis to a Women's Health Initiative Cohort: Results From the NKF-CRN Second National Research Question Collaborative Study

OBJECTIVE The objective of this study was to compare the characteristics and dietary intake of Second National Research Question (SNRQ) participants to the Womens Health Initiative-Dietary Modification (WHI-DM) Trial group and to compare the dietary intake of both groups to relevant reference norms. DESIGN The study design was a secondary analysis of data collected from the SNRQ and from the WHI-DM Trial. SUBJECTS SNRQ participants were adult women on dialysis (n = 248) from U.S. dialysis facilities. WHI-DM Trial participants (n = 48,836) were postmenopausal, 50- to 79-year-old women from 40 U.S. clinical centers. METHODS The 1-sample t test, χ(2), and Wilcoxon signed-rank test were used to compare the SNRQ participants to the WHI-DM group and to compare the dietary intake of both to nutrition reference norms. Differences were considered significant at a 2-tailed P ≤ .01. MAIN OUTCOME MEASURE Dietary intake was defined as dietary energy intake (DEI), dietary protein intake (DPI), fiber, fat, saturated fat, sodium, potassium, phosphorus, fruits, and vegetables. RESULTS Characteristics including age, race, weight, educational level, and cardiovascular disease differed between the SNRQ and WHI-DM groups (P < .001). SNRQ participants had lower DEI, DPI, fiber, fat, saturated fat, potassium, sodium, phosphorus, fruit, and vegetable intake than WHI-DM women (P < .001). Dietary intake of SNRQ hemodialysis (HD) and peritoneal dialysis (PD) patients differed significantly from reference norms (P < .001) except for phosphorus intake in PD patients (P = .03). WHI-DM women had higher intakes of fat and saturated fat and lower intakes of fiber, fruit, and vegetables than recommended in reference norms for the general population. CONCLUSION Dietary intake differed significantly between SNRQ participants and the WHI-DM group. Dietary intake of the SNRQ participants, except for phosphorus intake in PD patients, differed significantly from relevant reference norms.

Workplace weight loss program: impact on quality of life.

Objective: To determine the effectiveness of a 12-week workplace intervention program (WIP) focused on weight loss and reduction of cardiovascular risk factors on health-related quality of life (HRQOL) and the effect of delivery method on outcomes. Methods: A retrospective analysis of data collected in a 12-week trial comparing in-person (IP) and Internet-based (IB) intervention to identify the impact on HRQOL by utilizing the Centers for Disease Control and Prevention HRQOL-14 questionnaire. Results: Repeated-measure analysis of variance indicated no significant intervention effect for HRQOL by group assignment. Within subjects, significant main effect was noted for improvement in Summative Index of unhealthy days, sleeplessness, and vitality days at weeks 12 and 26. At week 26, significant main effect was found for improved mentally unhealthy and depression days. Conclusions: Improvement in HRQOL following a 12-week university-based WIP can occur independent of method of delivery (IP vs IB).

Effect of a Dietitian-managed Bone Algorithm on Serum Phosphorus Level in Maintenance Hemodialysis Patients

OBJECTIVE This study examined the effectiveness of a registered dietitian (RD)-managed bone metabolism algorithm compared with a non-RD (registered nurse and the nephrologist)-managed one on serum phosphorus (PO4) and related clinical outcomes (corrected serum calcium [cCa] level, intact parathyroid hormone [iPTH] level, incidence of parathyroidectomy) among in-center maintenance hemodialysis (MHD) patients. DESIGN AND SETTING The study was an 18-month retrospective review of adult MHD patients (n = 252) at 5 outpatient dialysis centers in western Massachusetts and Connecticut before and after change in the management of a comprehensive bone metabolism treatment algorithm (intravenous vitamin D, phosphate-binding medication, calcimimetic) from non-RD to RD. Calendar-matched timepoints representing 3-month averages during the non-RD- and RD-managed periods of the same algorithm were used for analyses. Comparisons of outcomes at non-RD-managed timepoint 2 (February 2009-April 2009) and RD-managed timepoint 6 (February 2010-April 2010) were performed considering potential demographic and clinical confounders. RESULTS On average, serum PO4 level was lower during the RD-managed timepoint 6 (5.17 ± 1.23 mg/dL; mean ± standard deviation) compared with non-RD-managed timepoint 2 (5.23 ± 1.24 mg/dL), although the difference between these calendar-matched timepoints was not statistically significant (F = .108, P = .74) after controlling for age, dietary intake (equilibrated normalized protein catabolic rate), and dialysis adequacy (equilibrated Kdrt/V). Mean cCa at RD-managed timepoint 6 (8.76 ± 0.65 mg/dL) was not significantly different from non-RD-managed timepoint 2 (8.79 ± 0.74), and the difference between serum iPTH level at timepoint 6 (363.0 ± 296.8 pg/mL) compared with timepoint 2 (319.8 ± 251.5 pg/mL) was nonsignificant (F = .650, P = .42) after controlling for age. There were fewer parathyroidectomies during the RD-managed period (0.8%) compared with the non-RD-managed period (1.6%). CONCLUSIONS RDs may be equally effective as non-RDs in bone metabolism algorithm management with respect to serum PO4, cCa, and iPTH control in MHD patients. Further research is needed to prospectively evaluate the effect of RD management on these bone mineral outcomes.

Impact of an Evidence-Based Practice Intervention on Knowledge and Clinical Practice Behaviors Among Registered Dietitians

Implementation of evidence-based practice in clinical practice is essential for safety, quality, cost, and reimbursement of dietetics services. This prospective randomized controlled trial aimed to measure changes in knowledge and practice behaviors of evidence-based practice after an educational intervention. The ability to interpret statistical results improved significantly in the intervention group. When motivation to change was controlled for over time, a higher total knowledge score was demonstrated in the intervention group. This finding suggests that motivation to change was an important factor for the adoption of evidence-based practice knowledge into clinical practice among registered dietitians.

Development of an interprofessional lean facilitator assessment scale

ABSTRACT High reliability is important for optimising quality and safety in healthcare organisations. Reliability efforts include interprofessional collaborative practice (IPCP) and Lean quality/process improvement strategies, which require skilful facilitation. Currently, no validated Lean facilitator assessment tool for interprofessional collaboration exists. This article describes the development and pilot evaluation of such a tool; the Interprofessional Lean Facilitator Assessment Scale (ILFAS), which measures both technical and ‘soft’ skills, which have not been measured in other instruments. The ILFAS was developed using methodologies and principles from Lean/Shingo, IPCP, metacognition research and Bloom’s Taxonomy of Learning Domains. A panel of experts confirmed the initial face validity of the instrument. Researchers independently assessed five facilitators, during six Lean sessions. Analysis included quantitative evaluation of rater agreement. Overall inter-rater agreement of the assessment of facilitator performance was high (92%), and discrepancies in the agreement statistics were analysed. Face and content validity were further established, and usability was evaluated, through primary stakeholder post-pilot feedback, uncovering minor concerns, leading to tool revision. The ILFAS appears comprehensive in the assessment of facilitator knowledge, skills, abilities, and may be useful in the discrimination between facilitators of different skill levels. Further study is needed to explore instrument performance and validity.

Effect of Aggressive Osteodystrophy Management on Clinical Outcomes in Stage 5 Chronic Kidney Disease

OBJECTIVE The study investigated whether the type of bone disease management (aggressive versus conventional) had an impact on clinical outcomes, namely bone health measures (e.g., biointact parathyroid hormone [BiPTH], serum corrected calcium [cCa] level, serum phosphorus [phos] level, and corrected calcium-phosphorus product [cCaPO(4)]). DESIGN AND SETTING Retrospective chart review of 173 closed medical records of maintenance hemodialysis patients on thrice-weekly therapy from January 1, 2005, through December 31, 2005. Two Conventional Management (i.e., control group) and three Aggressive Management (i.e., treatment group) dialysis facilities were enrolled. RESULTS There was a significant interaction for group assignment and BiPTH levels (F = 4.12, P = .01), with the Aggressive Group trending toward lower BiPTH levels than the Conventional Group. The Conventional Group experienced a significantly lower mean annualized serum cCa level (F = 8.85, P = .003), and used non-calcium-based binders significantly more (P < .0005) than the Aggressive Group. In terms of serum phos level, the Aggressive Group had a significantly lower (F = 2.73, P = .05) value than the Conventional Group. No significant differences were reported for cCaPO(4) product (F = 1.87, P = .17). The percentage of the total sample that achieved target range for all bone health measures included 29.8% (n = 50). CONCLUSIONS The study demonstrated that aggressive bone disease management appears to be as effective as traditional interventions in the treatment of mineral and bone metabolism disorders in chronic kidney disease.