bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reliability and validity of the Intercollegiate Stroke Audit Package
Authors: Gompertz P. H. , Irwin P. , Morris R. , Cstat D. Lowe MSc , Rutledge Z. , Rudd A. G. , Pearson M. G. 
Published: March 2003

AbstractThe aim of this study was to assure the validity and reliability of the Intercollegiate Stroke Audit Package as used in the National Sentinel Audit of Stroke. The Intercollegiate Working Party for Stroke, which included most stakeholders, including patients, devised the audit standards. These were submitted to a formal consensus (modified Delphi) survey before the audit questions were developed and piloted for validity and reliability. Following the pilot, Help Booklets were developed to promote the involvement of all disciplines as auditors in the national sentinel audit of stroke and ensure inter‐rater reliability. During the national audit each Trust was asked to double rate the first five cases with auditors of different disciplines working independently. A total of 886 case notes were double‐rated in 184 separate sites (median 5, range 1–5 per site). Trusts used auditors from different disciplines in 77% of cases. After excluding the ‘No answer’ cases the kappa score for items ranged from 0.49 to 0.87 (median 0.70, IQR 0.63–0.78). Very good agreement was found for seven of the 45 items, good agreement for 30 items, and moderate agreement for eight items. This large study, across a range of hospital sites and involving many disciplines, demonstrates that careful piloting of audit tools, with use of clear instructions to auditors, promotes the reliability of data.
How to validate clinically important change in health‐related functional status. Is the magnitude of the effect size consistently related to magnitude of change as indicated by a global question rating?
Authors: Middel Berrie , Stewart Roy , Bouma Jelte , Sonderen Eric van , Heuvel Wim J. A. van den 
Published: March 2003

AbstractSome clinical trials perform repeated measurement over time and estimate clinically relevant change in an instrument’s score with global ratings of perceived change or so‐called transition questions. The conceptual and methodological difficulties in estimating the magnitude of clinically relevant change over time in health‐related functional status (HRFS) are discussed. This paper investigates the concordance between the amount of serially assessed change with effect size estimates (the researcher’s perspective) and global ratings of perceived change (the patient’s perspective). A total of 217 patients who were scheduled for diagnostic examination were included, and the Minnesota Living with Heart Failure Questionnaire, extended with MOS‐20 items, was assessed before and after medical intervention (percutaneous transluminal coronary angioplasty, coronary artery bypass grafting or pharmaco‐therapy). Global questions were applied to assess perceived change over time for every item from domains of physical and emotional functioning and used as the external criterion of relevant change in the analysis of items. Global questions corresponding with overall change in these domains were used in the comparison of change in physical and emotional functioning scales. Two effect size indices were used: (i) ES (mean change/SDpooled) and (ii) ES (mean change/SDchange). A method is described to calculate a value indicating the extent of discordance between the researcher’s interpretation of magnitude of change and the external criterion (the patient’s perspective). Findings suggest that effect size (ES) (mean change/SDpooled) was in keeping with the magnitude of change indicated by patients’ judgements, or their category of subjective meaning, for all scales. Furthermore, in cases in which the magnitude of change estimated with the SRM (mean change/SDchange) was not confirmed empirically by the external criterion ratings, the discordance could be interpreted as a trivial discordance.
Explaining the use and non‐use of community‐based long‐term care services by caregivers of persons with dementia
Authors: Markle‐Reid Maureen , Browne Gina 
Published: March 2003

AbstractThe purpose of this paper is to synthesize and critically evaluate the current literature that explains the use and non‐use of formal community‐based long‐term care services by caregivers of persons with dementia. There are four issues related to formal community service use by caregivers: reluctance to initiate formal services; under‐utilization of available services; delayed utilization of services; and inappropriate utilization of services. Despite substantial research efforts to understand these issues, the reasons for low rates of community service use by this population remains unclear. Common methodological problems and limitations in the underlying theoretical assumptions in the literature, as they relate to caregivers of persons with dementia, have limited the usefulness of the current research for informing practice and policy. A conflict‐theory model of decision‐making is proposed as an alternative theoretical framework for understanding the particularity and complexity of the decision‐making process leading up to the initiation of formal service use. Utilization of formal services is a result of a complex and subjective decision‐making process that is unrelated to objective circumstances. The proposed conflict theory model of decision‐making can inform policy and practice regarding the development of appropriate, timely and individualized interventions to facilitate the use of formal services by caregivers of persons with dementia.
Monoamine oxidase drugs and diet
Authors: Merriman S. H. 
Published: March 2003

Summary Aims: To review the literature on monoamine oxidase drugs and propose a simple diet sheet. Methods: A literature search, using a range of computer data bases and the assistance of the Mental Health Group of the British Dietetic Association. Results: MAO‐B drugs (e.g. Selegiline) do not require dietary restrictions. MAO‐A drugs and MAOI drugs do require a restriction of the intake of tyramine. The manufacturer (Roche) of Manerix (moclobemide), an MAO‐A drug, states that not more than 50 g of cheese should be eaten when taking that medication. MAOI drugs (e.g. Isocarboxazid (Cambridge), Nardil (P‐D), Parnate (SK & F)) require further dietary restrictions. Patients taking MAOI drugs should not consume more than 6 mg tyramine in a single dose (i.e. a meal or snack). Conclusion: A simple diet sheet, for use with MAOI drugs, has been devised. It lists the foods which must be avoided, those which may be taken in moderation and those which may be eaten freely.
An assessment of compliance with nutrition criteria and food purchasing trends in Heartbeat Award premises
Authors: Holdsworth M. , Haslam C. , Raymond N. T. 
Published: March 2003

Summary Background: The Heartbeat Award scheme (HBA) was initiated in Leicestershire in 1990. An evaluation of compliance of HBA premises with nutrition criteria and an assessment of the impact of the scheme on food purchasing trends has not been previously reported. Method: Twenty‐three caterers (12 workplaces and 11 public eating places) responsible for implementing the scheme were interviewed to establish the extent to which premises continued to comply with nutrition criteria; whether healthy food choices were being marketed after receiving the HBA; and caterers assessment of food purchasing trends. Data were collected during face‐to‐face interviews using a questionnaire and checklist. Results: All workplaces complied with 11 of the 34 nutrition criteria, and all public eating places complied with 22 of the 34 nutrition criteria. A quarter of caterers reported not providing one‐third of all menu sections as healthy choices. Three‐quarters of establishments used a symbol to highlight healthy food choices. This was the only form of promotion in most cases. At least a quarter of premises reported an increase in sales of some healthier food items. Even so, the uptake of less healthy choices remained the same in most premises. Conclusion: The lack of compliance locally with so many nutrition criteria is a major concern. This raises the question of whether scarce dietetic resources are being used appropriately without a system for monitoring.
A3. Can linseed (flaxseed) help to regulate blood glucose levels when incorporated into the diabetic diet?
Authors: Booth S. K. 
Published: March 2003

Background It has been suggested that linseed (flaxseed) may help to reduce the risk of heart disease and cancer due to its relatively high concentration of both alpha‐linolenic acid and nonstart polysaccharides (
Vaisey‐Genser & Morris, 1997). In view of this, and given the associated risk of heart disease with diabetes (
Fuller et al. 1980
), can linseed be used in the diabetic diet to help regulate blood glucose levels?Aim The aim of this experimental crossover design study was to investigate the glycaemic response of linseed in scones compared to white bread (a standard reference food).Method Fifteen healthy female subjects (n = 15) participated in two single‐meal study periods with a 7‐day washout period in‐between. Finger prick blood samples were taken at 30, 60, 90 and 120 min postprandial and analysed using the Reflotron glucose method (
Boehringer Mannheim, 1974).Results Using anova, a significant difference was found between the incremental blood glucose values following consumption of the linseed scone in comparison with the white bread [P < 0.008], which demonstrated that there was a more gradual glycaemic response with the linseed scone.Conclusion As diabetics should avoid severe peaks and troughs in their blood glucose levels, linseed may help to regulate blood glucose when incorporated into certain foods which have a relatively high glycaemic response, e.g. bread.
A7. A survey of current dietary recommendations for post‐transplant renal patients in the UK and Ireland
Authors: MaCleod R. 
Published: March 2003

Background In recent years there has been a rise in medical knowledge and scientific information in the area of nutritional disorders and nutritional treatment in patients with renal disease and those with acute or chronic renal failure.Aim To establish the current dietary management of renal transplant patients in the United Kingdom (UK) and Ireland.Methods A total of 47 renal transplant units were identified in the UK and Ireland and a postal questionnaire was sent to each of these units.Results Thirty‐three units replied giving a 70% response rate: Only one did not have a dietitian to advise transplant recipients on their diet. In the majority of units energy requirements of early and late post‐transplant patients were calculated using 30–35 kcal/kg/day or using the Schofield equations. 42% of units gave early post‐transplant weight loss advice for the overweight patient but 88% of units gave late post‐transplant weight loss advice. 52% or units at both early and late transplant stages gave advice on weight gain for underweight or malnourished patients.50% of total energy intake from carbohydrate was frequently recommended in early and late post‐transplant, with restriction of simple sugars as required. A fat intake early post‐transplant of 30% of total energy intake was prescribed by the majority of respondents with a fat intake of less than 30% of total energy intake during late post‐transplant stage to control for hyperlipidaemia, improved graft outcome and to encourage healthier eating. 18% of transplant units reported that vitamins and minerals would be supplemented early and late post‐transplant, if the patient had a poor appetite, inadequate diet or if nutrient deficient.Conclusions The dietary prescriptions were similar except for some variation in protein and electrolyte prescriptions. The findings from this study indicate that a policy on dietary management for post‐transplant patients could be developed with respect to Carbohydrate, Fat and Energy prescription. Protein and electrolytes should continue to be calculated on an individual basis by a renal transplant unit dietitian. It was noted that dietitians adapted their recommendations for individual care in relation to changes in nutritional and biochemical status.This study also highlighted the need for further research to be conducted on optimal protein and micronutrient prescriptions with respect to immunosuppressive drug interactions and graft survival.
Nutrition Assessment Score validation and the implications for usage
Authors: Oakley C. , Hill R. 
Published: March 2003

Introduction Malnutrition in hospital is a well‐documented and significant problem and contributes to increased recovery times, length of stays, cost to the NHS and patient mortality and morbidity. Malnutrition in hospitals has been found to be in excess of 40% of admissions. In spite of the fact that nutritional support has been found to benefit patients, referral rates to dietetic services do not reflect these levels. A study was carried out in Hairmyres Hospital to validate a nutritional assessment score (NAS) and assess the benefits and costs of introducing this assessment as a routine part of nursing care.Methods  An NAS was completed for all patients admitted to two medical and two surgical wards over a 4‐week period and nutritionally assessed by a dietitian. Assessment was carried out on admission and weekly thereafter, for 118 patients, resulting in a total of 150 assessments.Results  With a scoring system of: On Admission: Refer if score is 6 or above, On Review: Refer if score is 4 or above, it was found that 92% of patients at risk of malnutrition would be appropriately referred on admission and 100% of those patients not appropriately referred would be referred on review.Discussion and conclusions The study shows the NAS to be a valid tool for nutritional assessment and a useful aid to nursing staff in assessing risk of malnutrition and need for nutritional support. It suggests that the NAS could be used to indicate the need for nursing and dietetic intervention. The Dietetic Department could anticipate approximately 1880 new nutritional support referrals per year from general medical and surgical wards. The introduction of such an assessment tool has resource implications for dietitians, nurses and catering staff but should provide benefits to the patients and the hospital.
Nutrition and diet in the clinical management of multiple sclerosis
Authors: Payne A. 
Published: March 2003

For many years, medical interest in the relationship between nutrition and multiple sclerosis (MS) has focused largely on aetiology and the influence of dietary fat on the rate and severity of disease. While the cause of MS remains unknown and the influence of dietary fat is unclear, recent studies on antioxidant intake and oxidative stress in MS are strengthening the rationale in support of a healthy eating regime following diagnosis.Dietary intake in MS and the influence of advanced disease on nutritional status are less well researched and documented. Both obesity and malnutrition may occur with detrimental consequences to functional abilities. Cognitive difficulties, dysphagia and the side‐effects of drug treatment may further contribute to deterioration in nutritional status.This paper aims to provide a practical overview of dietary management in MS. It reviews the available evidence relating nutrition to MS and discusses dietary management, with particular emphasis on the identification and alleviation of factors affecting nutritional status.
The relative validity of a short Dutch questionnaire as a means to categorize adults and adolescents to total and saturated fat intake
Authors: Van Assema P. , Brug J. , Ronda G. , Steenhuis I. 
Published: March 2003

BackgroundTo assess the relative validity of a short food frequency questionnaire, the Fat list, to be used in (the evaluation of) nutrition education programmes.MethodsForty‐five adults and 50 adolescents (12–18 years old) completed the Fat list at home, and subsequently kept diet records for seven subsequent days.ResultsPearson correlations of about 0.7 for adults and 0.6 for adolescents were observed between fat scores derived from the Fat list and total and saturated fat intake in grams estimated by the 7‐day diet records. Correlations varied among subpopulations based on sex, age, education, household size and responsibility for cooking and shopping. Lower correlations were especially found for female adolescents and older adolescents (16–18 years old). Pearson correlations between the Fat list and percentages energy from fat were low for both adults and adolescents. Gross misclassification, defined as disagreement between the two fat consumption assessments beyond an adjacent tertile, was less than 6% for all but the female adolescents.ConclusionsThe Fat list can be used in adult and male adolescent populations to classify subjects in broad categories of total and saturated fat intake in grams and to assess differences in absolute and saturated fat intake between groups as a result of nutrition education programmes.
Intensive lifestyle intervention combined with the choice of pharmacotherapy improves weight loss and cardiac risk factors in the obese
Authors: Frost G. , Lyons F. , Bovill‐Taylor C. , Carter L. , Stuttard J. , Dornhorst A. 
Published: March 2003

AbstractBackground  Obesity is on the increase yet within the National Health Service (NHS) treatment approaches differ greatly and service is patchy. Our aim was to compare current practice within a general dietetic clinic with a new clinic developed specifically for patients of higher morbidity risk.Methods  Locally referred patients to the dieticians from within or without Hammersmith Hospitals NHS Trust of higher morbidity risk were invited to attend a new Lifestyle Clinic. Treatment was of a contractual nature and included more time with the dietitian, the offer of pharmacotherapy if appropriate and an emphasis on achieving a realistic weight loss of 10% within a 6‐month period. Cognitive behavioural strategies were utilized focusing on achieving changes in dietary intake and physical activity levels.Results  A total of 103 patients have been enrolled of whom 34 have been discharged before completion of the clinic programme. Twenty‐six patients have completed (18 started pharmocotherapy with Orlistat and eight remained on lifestyle advice only), with the remainder still attending the Lifestyle Clinic. The results for these 26 patients demonstrate clinically significant benefits with regard to exercise tolerance390.8 ± 37.5 m vs. 473 ± 46.6 m (P < 0.001), waist measurement 121.5 ± 4.4 cm vs. 110.9 ± 3.6 cm (P < 0.001), and total cholesterol : HDL ratio 1.17 ± 0.05 mmol L−1 vs. 1.27 ± 0.07 mmol L−1 (P < 0.05). A weight loss comparison with historical data collected in the general dietetic clinic achieves a 7.8 ± 0.7 kg reduction in weight (with pharmocotherapy 8.96 ± 0.98 kg, with lifestyle only 5.23 ± 0.657) vs. 1.7 ± 0.4 kg (P < 0.05).Conclusion  Lifestyle clinics facilitate beneficial lifestyle changes which impact positively on morbidity risk factors demonstrating an improvement on current service offered within the NHS. There is an obvious resource implication of offering an intensive management package. There is need for a randomized control trial with analysis to evaluate whether there is cost benefit from this type of intervention.
Dietitians' views of overweight and obese people and reported management practices
Authors: Harvey E. L. , Summerbell C. D. , Kirk S. F. L. , Hill A. J. 
Published: March 2003

AbstractObjectives  To examine dietitians' views of overweight and obese people, to explore the role of level of severity on these perceptions (overweight vs. obesity), and to explore the relationship between dietitians' views and their reported weight management practices.Design  An independent measures survey, questioning dietitians about either overweight or obese people.Participants  One‐hundred and eighty‐seven members of the British Dietetic Association.Measurements  A questionnaire exploring beliefs about the causes, attitudes, perceptions of responsibility and reported weight management practices.Results  Physical inactivity was identified as an important causative factor for both overweight and obesity. Mood, eating too much of the wrong foods, repeated dieting and interpersonal factors were also seen as relatively important for both groups. Attitudes were mixed, but were generally neutral to positive. The most negative attitudes were described in terms of perceived reduced self‐esteem, sexual attractiveness and health. Dietitians rated obese people more negatively than overweight people. They viewed both overweight and obese people as being responsible for their excess weight. They also reported very similar management practices for overweight and obese people. Beliefs about the causes of overweight explained more of the variance in practice than dietitians' attitudes towards or perceived responsibility of overweight and obese people. However, these associations were not consistent and strong, and other factors not investigated here are likely to have a greater influence on weight management practices.
The prevalence of constipation in institutionalized people with intellectual disability
Authors: Böhmer C. J. M. , Taminiau J. A. J. M. , Klinkenberg‐Knol E. C. , Meuwissen S. G. M. 
Published: March 2003

AbstractConstipation is a common problem in people with intellectual disability (ID). Laxatives are frequently prescribed with disappointing results. The prevalence of constipation was investigated in a random population of 215 people with ID (IQ < 50) and constipation was correlatead with clinical symptoms. All subjects were scored for bowel habits. Constipation was defined as having a bowel movement less than three times a week or the necessity of using laxatives more than three times a week. Further possible accompanying factors were evaluated. The control subjects were defined as individuals who did not use laxatives. Subjects with constipation were defined as patients and were compared to subjects without constipation (controls). One hundred and forty‐nine out of 215 cases (69.3%) showed constipation. Constipation was significantly correlated with non‐ambulancy, cerebral palsy, the use of anticonvulsive medication or benzodiazepines, H2‐receptor antagonists or proton pump inhibitors, food refusal, and an IQ < 35. Fifty‐eight per cent of the patients used bisacodyl or magnesium oxide, 39% lactulose, 13% sodiumlaurylsulphoacetate/sodium citrate/sorbitol and only 10% were given sodium phosphate enemas. Faecal soiling was found in 15% of subjects, while manual evacuation of faeces was performed in nearly 7% of cases. Constipation was randomly demonstrated in almost 70% of the population with ID. Subjects with the above‐mentioned accompanying factors are especially at risk for constipation. Contrary to the general population, constipation in people with ID is associated with little use of phosphate enemas, microlax, a low incidence of faecal soiling and manual evacuation of faeces, suggesting an aetiology without distal faecal impaction. The regimen and effect of therapy has to be studied to define adequate treatment schedules.
Complexity of staff communication and reported level of understanding skills in adults with intellectual disability
Authors: Bradshaw J. 
Published: March 2003

AbstractStaff reports of the communication acts taking place with 22 adults with intellectual disability were compared with video observations of the communication acts used by staff with 12 of these service users. The interactions were coded in terms of the form of communication used, the function of the act and the level of complexity. The results show that staff tend to underestimate their own use of verbal communication and overestimate their use of non‐verbal communication. The findings also indicate a mismatch between the reported level of understanding of the service user and the level of complexity of the language used. Staff appeared unable to adapt their communication to the skills of the service user and an average of 45% of communicative acts were outside the reported understanding skills of the individual. The implications of these findings are discussed and possible explanations for staff behaviour are suggested.