Medicalised Ketogenic Therapy Practice
Authors:   , Tan-Smith Charlene 
Published: July 2024

I have embarked on the Doctorate of Professional Practice (DProfPrac) program through Te Pūkenga New Zealand Institute of Skills and Technology, New Zealand. My aspirational professional practice statement is to be a change agent bringing necessary disruption to medicalised ketogenic therapy delivery practice, nationally and internationally. The impact I want is the opportunity for practitioners to change to an individualised patient care model by applying technology and associated artificial intelligence. My purpose for this disruption is to impact the challenges to the practice of ketogenics in a positive way. Children with refractory epilepsy can suffer hundreds of seizures daily and do not respond to antiepileptic drugs. As of early 2023, in New Zealand, access to therapy is restricted to paediatrics by geographical location, capacity and ketogenic diet type. Comparable OECD countries experience similar challenges. Accessibility and adherence to the ketogenic diet are affected by the available digital tools. The first-generation manual calculators do not mitigate the time and effort overhead of the therapy's algorithmic requirements. The Doctorate of Professional Practice differs from a traditional doctorate in considering every component of the clinician's practice. The result is personal and professional transformation through autoethnographic action research projects. I developed a Herea (weaving together) model of people, process and technology while establishing the new South Island service. The aim was to intentionally design the service suited to our geographically spread regional population. I provide technical information for how ketogenic meal and recipe auto-balancing technology developed while addressing accuracy, time-saving, variety of foods and custom food choice exchange blocks. In the primary action research, I identify the Theoretical Framework of Acceptability comprising seven component constructs and apply it to the KetoSuiteTM auto-balancing suite of applications through qualitative and quantitative interviewing of patient carers. Apart from obtaining a unitary and multi-faceted acceptability measure, fundamental and controversial topics regarding the challenges of delivering medicalised ketogenic therapy emerged as themes through reflective practice. This analysis includes the origins of ratios, prescription labels and targets, methodologies and application of technology. Other chapters covered hub and spoke service establishment and a medicalised ketogenic therapy human lactation case study. The final chapter presents the professional practice of learning outcomes, aspirational professional practice and grande reflection. Reflection on every component of my practice made me question and investigate fundamental assertions of medicalised ketogenic delivery. I do not intend for these chapters to point the finger or denigrate any particular practice but rather facilitate conversation to encourage deeper appreciation amongst practitioners and to work collaboratively on solutions to help improve the outcomes for a vulnerable group of health care consumers. These reflections and action research have culminated in my identification of the Ketogenic Algorithmic Challenge, the fundamental core of every medicalised ketogenic challenge.