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Viner Smith E, Kouw IWK, Summers MJ, Louis R, Trahair L, O'Connor SN, Jones KL, Horowitz M, Chapman MJ, Chapple LAS. Comparison of energy intake in critical illness survivors, general medical patients, and healthy volunteers: A descriptive cohort study. JPEN J Parenter Enteral Nutr 2024; 48:275-283. [PMID: 38424664 DOI: 10.1002/jpen.2612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Intensive care unit (ICU) survivors have reduced oral intake; it is unknown whether intake and associated barriers are unique to this group. OBJECTIVE To quantify energy intake and potential barriers in ICU survivors compared with general medical (GM) patients and healthy volunteers. DESIGN A descriptive cohort study in ICU survivors, GM patients, and healthy volunteers. Following an overnight fast, participants consumed a 200 ml test-meal (213 kcal) and 180 min later an ad libitum meal to measure energy intake (primary outcome). Secondary outcomes; taste recognition, nutrition-impacting symptoms, malnutrition, and quality of life (QoL). Data are mean ± SD, median (interquartile range [IQR]) or number [percentage]). RESULTS Twelve ICU survivors (57 ± 17 years, BMI: 30 ± 6), eight GM patients (69 ± 19 years, BMI: 30 ± 6), and 25 healthy volunteers (58 ± 27 years, BMI: 25 ± 4) were included. Recruitment ceased early because of slow recruitment and SARS-CoV-2. Energy intake was lower in both patient groups than in health (ICU: 289 [288, 809], GM: 426 [336, 592], health: 815 [654, 1165] kcal). Loss of appetite was most common (ICU: 78%, GM: 67%). For ICU survivors, GM patients and healthy volunteers, respectively, severe malnutrition prevalence; 40%, 14%, and 0%; taste identification; 8.5 [7.0, 11.0], 8.5 [7.0, 9.5], and 8.0 [6.0, 11.0]; and QoL; 60 [40-65], 50 [31-55], and 90 [81-95] out of 100. CONCLUSIONS Energy intake at a buffet meal is lower in hospital patients than in healthy volunteers but similar between ICU survivors and GM patients. Appetite loss potentially contributes to reduced energy intake.
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Affiliation(s)
- Elizabeth Viner Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Imre W K Kouw
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Matthew J Summers
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Rhea Louis
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Stephanie N O'Connor
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Michael Horowitz
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Marianne J Chapman
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
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Page K, Viner Smith E, Chapple LAS. Nutrition practices in hospitalized adults receiving noninvasive forms of respiratory support: A scoping review. Nutr Clin Pract 2024; 39:344-355. [PMID: 37840215 DOI: 10.1002/ncp.11081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/14/2023] [Accepted: 09/17/2023] [Indexed: 10/17/2023] Open
Abstract
The use of noninvasive respiratory support is increasing, with noninvasive ventilation (NIV) and high-flow nasal cannula providing unique barriers to nutrition support. Limited data related to nutrition management for these patients in the intensive care unit (ICU) exist; however, the literature in non-critically ill patients is not well described, and its improvement may help to inform practice within the ICU. Therefore, a scoping review was conducted of MEDLINE, EmCare, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases on August 18, 2022, to identify original publications that included adult patients receiving noninvasive respiratory support in a hospital setting with data related to nutrition management. Data were extracted on study design, population, details of respiratory support, and concepts relating to nutrition management (grouped into nutrition screening, assessment, delivery route, intake, and anthropometry). Eleven studies were included, most of which were small (<100 patients), single-center, observational trials in patients receiving NIV only. Five studies reported results related to route of nutrition and nutrition assessment, two on anthropometry, and one each on quantifying intake and nutrition screening; some studies reported multiple parameters. There was a lack of consensus regarding the ideal method for nutrition assessment and route of nutrition. Oral nutrition was the route most frequently reported, yet calorie and protein delivery via this route were inadequate, and barriers to intake included poor appetite, fatigue, and patient cognition. Future research should address barriers pertinent to this population and the impact of nutrition on outcomes.
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Affiliation(s)
- Kaitlyn Page
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Elizabeth Viner Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Viner Smith E, Lambell K, Tatucu-Babet OA, Ridley E, Chapple LA. Nutrition considerations for patients with persistent critical illness: A narrative review. JPEN J Parenter Enteral Nutr 2024. [PMID: 38520657 DOI: 10.1002/jpen.2623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
Critically ill patients experience high rates of malnutrition and significant muscle loss during their intensive care unit (ICU) admission, impacting recovery. Nutrition is likely to play an important role in mitigating the development and progression of malnutrition and muscle loss observed in ICU, yet definitive clinical trials of nutrition interventions in ICU have failed to show benefit. As improvements in the quality of medical care mean that sicker patients are able to survive the initial insult, combined with an aging and increasingly comorbid population, it is anticipated that ICU length of stay will continue to increase. This review aims to discuss nutrition considerations unique to critically ill patients who have persistent critical illness, defined as an ICU stay of >10 days. A discussion of nutrition concepts relevant to patients with persistent critical illness will include energy and protein metabolism, prescription, and delivery; monitoring of nutrition at the bedside; and the role of the healthcare team in optimizing nutrition support.
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Affiliation(s)
- Elizabeth Viner Smith
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kate Lambell
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Dietetics and Nutrition, Alfred Health, Melbourne, Australia
| | - Oana A Tatucu-Babet
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Emma Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Dietetics and Nutrition, Alfred Health, Melbourne, Australia
| | - Lee-Anne Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
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Page K, Viner Smith E, Plummer MP, Ridley EJ, Burfield K, Chapple LAS. Nutrition practices in critically ill adults receiving noninvasive ventilation: A quantitative survey of Australian and New Zealand intensive care clinicians. Aust Crit Care 2024; 37:43-50. [PMID: 37714782 DOI: 10.1016/j.aucc.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/01/2023] [Accepted: 08/11/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Noninvasive ventilation (NIV) is frequently used in the intensive care unit (ICU), yet there is a paucity of evidence to guide nutrition management during this therapy. Understanding clinicians' views on nutrition practices during NIV will inform research to address this knowledge gap. OBJECTIVE The objective of this study was to describe Australian and New Zealand clinicians' views and perceptions of nutrition management during NIV in critically ill adults. METHODS A cross-sectional quantitative online survey of Australian and New Zealand medical and nursing staff with ≥12 months ICU experience was disseminated through professional organisations via purposive snowball sampling from 29 August to 9 October 2022. Data collection included demographics, current practices, and views and perceptions of nutrition during NIV. Surveys <50% complete were excluded. Data are represented in number (%). RESULTS A total of 152 surveys were analysed; 71 (47%) nursing, 69 (45%) medical, and 12 (8%) not specified. There was limited consensus on nutrition management during NIV; however, most clinicians (n = 108, 79%) reported that nutrition during NIV was 'important or very important'. Oral intake was perceived to be the most common route (n = 83, 55%), and 29 (21%) respondents viewed this as the safest. Most respondents (n = 106, 78%) reported that ≤50% of energy targets were met, with gastric enteral nutrition considered most likely to meet targets (n = 55, 40%). Reported nutrition barriers were aspiration risk (n = 87, 64%), fasting for intubation (n = 84, 62%), and nutrition perceived as a lower priority (n = 73, 54%). Reported facilitators were evidence-based guidelines (n = 77, 57%) and an NIV interface compatible with enteral nutrition tube (n = 77, 57%). CONCLUSION ICU medical and nursing staff reported nutrition during NIV to be important; however, there was a lack of consensus on the route of feeding considered to be the safest and most likely to achieve nutrition targets. Interventions to minimise aspiration and fasting, including an interface with nasoenteric tube compatibility, should be explored.
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Affiliation(s)
- Kaitlyn Page
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia.
| | - Elizabeth Viner Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia; Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
| | - Mark P Plummer
- Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
| | - Emma J Ridley
- ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Kristy Burfield
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia.
| | - Lee-Anne S Chapple
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia; Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
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Malli A, Monteith H, Hiscock EC, Smith EV, Fairman K, Galloway T, Mashford-Pringle A. Impacts of colonization on Indigenous food systems in Canada and the United States: a scoping review. BMC Public Health 2023; 23:2105. [PMID: 37885000 PMCID: PMC10601184 DOI: 10.1186/s12889-023-16997-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Indigenous populations in Canada and the United States (US) have maintained reciprocal relationships with nature, grounded in respect for and stewardship of the environment; however, disconnection from traditional food systems has generated a plethora of physical and mental health challenges for communities. Indigenous food sovereignty including control of lands were found to be factors contributing to these concerns. Therefore, our aim was to conduct a scoping review of the peer-reviewed literature to describe Indigenous disconnection from Indigenous food systems (IFS) in Canada and the US. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-SR) and Joanna Briggs Institute guidelines, we searched MEDLINE, SCOPUS, International Bibliography of the Social Sciences, Sociological Abstracts, and Bibliography of Native North Americans. Data was extracted from 41 studies and a narrative review completed based on study themes. RESULTS The overarching theme identified in the included studies was the impact of colonization on IFS. Four sub-themes emerged as causes for Indigenous disconnection from traditional food systems, including: climate change; capitalism; legal change; and socio-cultural change. These sub-themes highlight the multiple ways in which colonization has impacted Indigenous food systems in Canada and the US and important areas for transformation. CONCLUSIONS Efforts to reconnect Indigenous knowledge and values systems with future food systems are essential for planetary health and sustainable development. Traditional knowledge sharing must foreground authentic Indigenous inclusion within policymaking.
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Affiliation(s)
- A Malli
- Imperial College London, London, SW7 2AZ, UK
| | - H Monteith
- Department of Anthropology, University of Toronto Mississauga, 3359 Mississauga Rd, Mississauga, ON, L5L 1C6, Canada
| | - E C Hiscock
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue Suite 160, Toronto, ON, M5G 1V7, Canada
| | - E V Smith
- Dalla Lana School of Public Health, Waakebiness Institute for Indigenous Health, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M7, Canada
| | - K Fairman
- Institute for Circumpolar Health Research, 3506 MacDonald Drive, Yellowknife, NT, X1A 2H1, Canada
| | - T Galloway
- Department of Anthropology, University of Toronto Mississauga, 3359 Mississauga Rd, Mississauga, ON, L5L 1C6, Canada
| | - A Mashford-Pringle
- Dalla Lana School of Public Health, Waakebiness Institute for Indigenous Health, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M7, Canada.
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Viner Smith E, D'Cruz RF, Chapple LA. Nutrition therapy during noninvasive ventilation: oral or enteral? Curr Opin Crit Care 2023:00075198-990000000-00091. [PMID: 37306535 DOI: 10.1097/mcc.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE OF REVIEW Critical care nutrition guidelines primarily focus on patients receiving invasive mechanical ventilation, yet noninvasive ventilation (NIV) is an increasingly common intervention. The optimal route of nutrition delivery in patients receiving NIV has not been established. This review aims to describe the implications of NIV on the route of feeding prescribed. RECENT FINDINGS Five small, mostly observational, studies have quantified energy or protein intake in patients receiving NIV in critical care, which demonstrate intake to be poor. No study has assessed the impact of feeding route on outcomes. The predominant route of feeding observed is oral intake, yet nutrition intake via this route is lower than that from enteral or parenteral nutrition. Barriers to oral intake include fasting for intubation, the inability to remove NIV apparatus to eat, breathlessness, fatigue and poor appetite, while barriers to enteral nutrition include the impact of the naso-enteric tube on the mask seal and potential aspiration. SUMMARY Although evidence to support the optimal route of feeding is developed, patient safety should be the key driver of route selection, followed by the ability to achieve nutrition targets, perhaps utilizing a combination of routes to overcome barriers to nutrition delivery.
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Affiliation(s)
- Elizabeth Viner Smith
- Intensive Care Unit, Royal Adelaide Hospital
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rebecca F D'Cruz
- Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Lee-Anne Chapple
- Intensive Care Unit, Royal Adelaide Hospital
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Viner Smith E, Ridley EJ, Rayner CK, Chapple LAS. Nutrition management of critically ill adult patients requiring non-invasive ventilation: a scoping review protocol. JBI Evid Synth 2022; 20:1814-1820. [PMID: 36164714 DOI: 10.11124/jbies-21-00328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This scoping review will identify the current available literature and key concepts in the nutrition management of critically ill adult patients requiring non-invasive ventilation. INTRODUCTION Current international nutrition guidelines include recommendations for the nutrition management of critically ill patients who are receiving invasive mechanical ventilation; however, these guidelines do not address nutrition management of patients receiving non-invasive ventilation. This scoping review aims to explore and describe the existing available literature on the nutrition management of critically ill adults requiring non-invasive ventilation. INCLUSION CRITERIA This review will consider original research (qualitative, quantitative, or mixed methods studies) reporting on any nutrition parameter for critically ill adult patients (≥16 years) requiring non-invasive ventilation in the intensive care unit. Concepts of interest based on the general intensive care nutrition literature include route of nutrition, recommendations related to macro- or micro-nutrients, nutrition provision, barriers to nutrition provision, and strategies for nutrition management. METHODS This review will be conducted in accordance with JBI methodology for scoping reviews using a three-step search strategy. MEDLINE, Embase, Scopus, and Web of Science will be searched to obtain original research available in English and published after 1990. Google Scholar will be searched for gray literature. Duplicates will be removed and studies will be selected by two independent reviewers based on the inclusion criteria. The same two reviewers will extract data in duplicate using a data extraction tool. Any disagreements will be resolved via consensus with a third reviewer. Data extraction will be synthesized in tabular and diagrammatic format.
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Affiliation(s)
- Elizabeth Viner Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Vic, Australia.,Nutrition Department, Alfred Health, Melbourne, Vic, Australia
| | - Christopher K Rayner
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia.,Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
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Hendrie GA, Viner Smith E, Golley RK. The reliability and relative validity of a diet index score for 4-11-year-old children derived from a parent-reported short food survey. Public Health Nutr 2014; 17:1486-97. [PMID: 23830074 PMCID: PMC10282435 DOI: 10.1017/s1368980013001778] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 04/08/2013] [Accepted: 05/20/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the reliability and relative validity of a diet index score derived from a Short Food Survey (SFS). DESIGN The thirty-eight-item SFS was designed to assess recent dietary intake of 4-11-year-olds to enable calculation of the Dietary Guideline Index for Children and Adolescents. Reliability was assessed based on two online administrations of the SFS, one week apart. Relative validity was assessed by comparing intakes derived from the SFS with those from the mean of three 24 h recalls. Intra-class correlations, Bland-Altman plots and estimated biases were assessed. Cohen's κ coefficients were used to determine the level of agreement between the two methods. SETTING Adelaide, Australia. SUBJECTS Sixty-three parents reported on their children's intake (mean age 7·1 (sd 2·1) years). RESULTS The intra-class correlation for reliability ranged from 0·43 for dairy foods to 0·94 for beverages, and was 0·92 for total diet index score (all P < 0·01). The intra-class correlation for validity ranged from 0·04 for meat and alternatives to 0·41-0·44 for fruit, beverages and extra foods, and was 0·44 for the total diet index score. The SFS overestimated the mean diet index score by 16 %, and the bias was consistent across levels of compliance. The percentage agreement into tertiles of index scores was 84% between the administrations of the two SFS, but only 43 % when comparing the SFS with the mean of the recalls. CONCLUSIONS The SFS can provide a consistent estimate of overall compliance to dietary guidelines for children aged 4-11 years, but overestimated the total diet index score by 16 % across all levels of compliance.
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Affiliation(s)
- Gilly A Hendrie
- CSIRO, Animal Health and Food Sciences, PO Box 10041, Adelaide BC, SA 5000, Australia
| | - Elizabeth Viner Smith
- CSIRO, Animal Health and Food Sciences, PO Box 10041, Adelaide BC, SA 5000, Australia
- Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia
| | - Rebecca K Golley
- Department of Public Health, University of South Australia, Adelaide, South Australia, Australia
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Affiliation(s)
- E V Smith
- Departments of Dermatology, University Hospital of Wales, Cardiff, UK.
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Abstract
This review highlights clinically important findings about acne treatment identified in nine systematic reviews published or indexed in the period March 2009 to February 2010. A systematic review of dietary influences on acne suggested that a possible role of dietary factors in acne cannot be dismissed, as the studies to date have not been sufficiently large or robust. Another review looked at benzoyl peroxide, which may be enjoying a comeback because of increasing bacterial resistance to antibiotics, and suggested that there was a lack of evidence that stronger preparations were more effective than weaker ones. The same team also carried out a systematic review addressing the question of whether topical retinoids cause an initial worsening of acne. They found no evidence to suggest initial worsening of acne severity, although there was evidence of skin irritation that typically settled by 8-12 weeks. A review of oral isotretinoin and psychiatric side-effects reinforced a possible link between the two, although it pointed out that the better-quality primary studies were still inconclusive. An updated Cochrane Review confirmed the efficacy of combined oral contraceptives (COCs) in reducing acne lesion counts. It also found that the evidence to support COCs containing cyproterone acetate over others was very limited. Another Cochrane Review failed to show any benefit of spironolactone for acne, based on limited studies. Three reviews examined laser and light therapies, and found some evidence of superiority only for blue or blue/red light treatment over placebo light, but a general absence of comparisons against other acne treatments. Photodynamic therapy had consistent benefits over placebo but was associated with significant side-effects and was not shown to be better than topical adapalene.
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Affiliation(s)
- E V Smith
- University Hospital of Wales, Cardiff, UK
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Smith EV, Johnson BD. Attention Deficit Hyperactivity Disorder: scaling and standard setting using Rasch measurement. J Appl Meas 2002; 1:3-24. [PMID: 12023555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
This paper explores the dimensionality of responses to the Adult Behavior Checklist Revised, a screening assessment for Attention Deficit Hyperactivity Disorder (ADHD) in college students, and demonstrates a standard setting process for diagnostic rating scales. Responses from 317 undergraduate college students were used to investigate dimensionality; 8 judges were used for the standard setting procedure. A series of Rasch rating scale analyses support the interpretation of Inattention and Impulsivity/Hyperactivity variables. Principal component analyses of residuals identified the existence of secondary variables that may have clinical implications for the evaluation and treatment of ADHD. For the standard setting process, judges generally displayed less variability than expected by the model. Several judges were in disagreement as to the level of symptomatology needed to indicate potential ADHD. The derived standard for Inattention was found to be more stringent than a previously suggested standard while the derived standard for Hyperactive/Impulsive more lenient. Prevalence rates found a diagnosis of Hyperactive/Impulsive to be more common than a diagnosis of Inattention. Efficient screening assessments for ADHD in college students are needed in order to determine who may qualify for further evaluation and special services. The standard setting process attempts to identify judge disagreement regarding the level of symptomatology (the standard) needed to qualify for additional evaluation and identify judge response strings not consistent with the item difficulties. Recommendations suggesting additional work on the screening assessment and standard setting process are outlined.
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Affiliation(s)
- E V Smith
- University of Illinois at Chicago, 1040 West Harrison Street, M/C 147, Chicago, IL 60607, USA.
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Smith EV. Metric development and score reporting in Rasch measurement. J Appl Meas 2002; 1:303-26. [PMID: 12029173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
This article: 1) describes problems in score reporting with the True-Score Model, 2) presents a definition of the Rasch measurement unit, the logit, 3) reviews various transformations of the logit metric, and 4) provides examples of score reporting procedures. Two data sets are used. The first contains dichotomous data drawn from responses to a multiple-response statistics examination taken by Ph.D. students; the second contains polychotomous data from a self-efficacy assessment given to war veterans suffering from Post Traumatic Stress Disorder.
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Affiliation(s)
- E V Smith
- College of Education, Department of Educational Psychology, University of Illinois at Chicago, 1040 W. Harrison Street, M/C 147, Chicago, IL 60607, USA.
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Smith EV, Dupeyrat C. Toward establishing a unified metric for performance and learning goal orientations. J Appl Meas 2002; 2:312-36. [PMID: 12011502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Findings in the goal orientation literature are convoluted due to sample and scale dependent interpretations and potentially the use of inappropriate measurement models for ordinal data. The purpose of this investigation was to explore the possibility of developing a common metric in order to enhance communication among goal orientation researchers using different scales. A simultaneous calibration of four commonly used goal orientation scales was undertaken to investigate if item responses meet the unidimensionality requirement of Rasch models and hence provided a common metric. Participants were 305 third year psychology students at a large University in France. Results indicated that 30 of 36 learning goal and 28 of 33 performance goals items from the four scales defined unidimensional constructs. Correlations between person measures from the four scales and the simultaneous calibration for both learning goal and performance goals support the interpretation of unidimensional variables. Raw score to interval measure conversion tables provide goal orientation researchers using different scales a common metric for interpretation and statistical analyses. Limitations and extensions of this research are discussed.
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Affiliation(s)
- E V Smith
- College of Education, Department of Educational Psychology, University of Illinois at Chicago, 60607, USA.
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Abstract
To determine the magnitude of underreporting of Lyme disease, a random sample of Connecticut physicians was surveyed in 1993. The magnitude of underreporting was assessed by comparing physician estimates of Lyme disease diagnoses with reports of Lyme disease sent by physicians to the Connecticut Lyme disease surveillance system. Complete questionnaires were returned by 59 percent (412/698) of those surveyed. Of the 224 respondents who indicated that they had made a diagnosis of Lyme disease in 1992, only 56 (25 percent) reported a case of Lyme disease that year. Survey results suggested that, at best, only 16 percent of Lyme disease cases were reported in 1992. Physician underreporting of Lyme disease underestimates the public health impact of Lyme disease.
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Affiliation(s)
- J I Meek
- Connecticut Department of Public Health, New Haven, USA
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Smith EV. Evidence for the reliability of measures and validity of measure interpretation: a Rasch measurement perspective. J Appl Meas 2001; 2:281-311. [PMID: 12011511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
In an era of high stakes testing and evaluation in education, psychology, and health care, there is need for rigorous methods and standards for obtaining evidence of the reliability of measures and validity of inferences. Messick (1989, 1995), the Standard for Educational and Psychological Testing (American Psychological Association, American Educational Research Association, and National Council on Measurement in Education, 1999), and the Medical Outcomes Trust (1995), among others, have described methods that may be used to gather evidence for reliability and validity, but ignored the potential role Rasch measurement may contribute to this process. This article will outline methods in Rasch measurement that are used to gather evidence for reliability and validity and attempt to articulate how these methods may be linked with the current views of reliability and validity.
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Affiliation(s)
- E V Smith
- College of Education, Department of Educational Psychology, University of Illinois at Chicago, 60607, USA.
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Lusardi MM, Smith EV. Development of a scale to assess concern about falling and applications to treatment programs. J Outcome Meas 1997; 1:34-55. [PMID: 9661714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This study used Rasch methodology to pursue three goals. First, we sought to demonstrate the psychometric limitations of the Falls Efficacy Scale (Tinetti, Richman, & Powell, 1990). Second, we addressed these limitations using a simultaneous calibration of the Falls Efficacy Scale and Mobility Efficacy Scale items. Third, we review previous explorations of the self-efficacy construct in relationship to health behaviors and discuss a possible treatment program based on the simultaneous calibrated items and Social Cognitive Theory. Results indicate that responses from the Falls Efficacy Scale fail to assess the higher ends of the self-efficacy continuum. Simultaneous calibration of items improved this lack of scale definition. This initial work in assessing self-efficacy perceptions provides a theoretical framework for planning treatment programs that may be more cost effective than collecting performance measures.
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Affiliation(s)
- M M Lusardi
- University of Oklahoma, Department of Educational Psychology, Norman 73019, USA
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Smith EV, Kolodny NH, Gragoudas ES, Egan KM, Finn S, D'Amico DJ, Seddon JM. An NMR blood test for uveal melanoma? Invest Ophthalmol Vis Sci 1990; 31:993-7. [PMID: 2335461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In a recent article a simple nuclear magnetic resonance (NMR) blood test was suggested for the detection of the presence of cancer. The test's sensitivity to uveal melanoma of both pre- and posttreatment status has been investigated. Cases in this study were 95 patients with uveal melanoma, and controls were 70 participants in an ongoing case control study of retinal eye disease being conducted at the Massachusetts Eye and Ear Infirmary. Proton NMR evaluations at 4.7 T (200 MHz) were performed on plasma obtained from EDTA and citrated blood samples. The average line-width values were calculated from each spectrum. Statistical analysis revealed that mean proton NMR line widths were essentially equal for patients with treated (18.7 Hz) and untreated tumors (18.4 Hz) and for controls (18.5 Hz). Results based on this data set suggest that proton NMR spectroscopy has little predictive power in the detection of uveal melanoma or in the monitoring of therapy.
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Affiliation(s)
- E V Smith
- Howe Laboratory of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston 02114
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Abstract
With developments in proton and sodium imaging on eyes and ocular lesions, MRI has been rapidly advancing into the field of ophthalmology. Although many intraocular lesions have been T1 and T2 characterized, and MRI may aid in their diagnosis, there remain a few problems with the technique. One is the presence of motion artifacts which sometimes occur with lengthy scanning times. A patient must be imaged on the order of minutes with MRI. In addition ambiguities exist even with the T1 and T2 characterizations, although the specificity surpasses that of CT. Eventually these problems may be solved, but even now proton coupled with sodium imaging and other diagnostic techniques appear promising in the evaluation of ocular disorders.
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Affiliation(s)
- E V Smith
- Howe Laboratory of Ophthalmology and Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston 02114
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Smith EV. Learning from the past, improving upon the present: traditional and western medical systems at the juncture. J Health Soc Policy 1988; 1:109-30. [PMID: 10304501 DOI: 10.1300/j045v01n02_05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Each cultural group has a reality which consists of a formal multi-centuried tested system of beliefs and practices. That system potentially inhibits or facilitate the acceptance of newly introduced technology and ideas. Among the critical beliefs and practices are those related to health and well-being. This article compares and contrasts "western" and "traditional" medical systems located both in the United States and other parts of the world. It discusses health and policy related postures concerning the "traditional medical system" taken by several countries and organizations. It, further, provides an overview of some current trends related to the recognition and acknowledged value of traditional medicine world-wide.
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Affiliation(s)
- E V Smith
- Department of Sociology, Florida A&M University, Tallahassee
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Smith EV, Kolodny NH, Gragoudas ES, Rubin LG, Seddon JH, D'Amico DJ. Safety and effectiveness of magnetic resonance imaging of choroidal melanoma patients with episcleral tantalum rings after proton beam irradiation. Am J Ophthalmol 1988; 105:695-6. [PMID: 2837092 DOI: 10.1016/0002-9394(88)90075-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- E V Smith
- Retina Service, Massachusetts Eye and Ear Infirmary, Boston 02114
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Abstract
Acebutolol, a beta-1 selective beta blocker with intrinsic sympathomimetic activity has been shown to be an effective agent in chronic angina pectoris therapy, with twice or three times daily dosing. The long-term effects of 400 mg of acebutolol given only once a day versus placebo on exercise hemodynamics, ST segment depression, and rate pressure product were studied. Eleven patients (mean age, 60 +/- 12 years) with hypertension and chronic angina pectoris were enrolled. Resting heart rate was not significantly altered after therapy, (80 vs 72 bpm). Objective measurements from exercise treadmill tests showed significant reduction in peak heart rate from 130 to 103 bpm, systolic blood pressure from 197 to 167 mm Hg, rate pressure product (from 25 to 18 bpm-mm Hg X 1000), and ST depression in patients receiving acebutolol compared with those receiving placebo. No significant adverse effects were reported. These data indicate that acebutolol may be efficacious as once daily therapy for chronic stable angina pectoris.
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Affiliation(s)
- I L Piña
- Division of Cardiology, University of Miami School of Medicine, Florida
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Pina IL, Smith EV, Fuguet M, Baier HJ, Myerburg RJ. Reversal of ST depression and low maximal oxygen uptake after verapamil with normal coronary arteries and pulmonary disease. Am J Cardiol 1988; 61:955-6. [PMID: 3354481 DOI: 10.1016/0002-9149(88)90392-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- I L Pina
- Division of Cardiology, University of Miami School of Medicine, Florida
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Pina IL, Smith EV, Kessler KM, Myerburg RJ. Clinical parameters of adolescent Hispanic male hypertensive subjects: a new subject? J Clin Hypertens 1987; 3:262-70. [PMID: 3668589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We have previously reported an increased prevalence of elevated blood pressure in Hispanic adolescent males. The pressure elevation did not correlate with weight. In this study, we evaluated the response to antihypertensive therapy of eight adolescent Hispanic males found to have elevated pressure during high school screening. All patients were placed on placebo tablets b.i.d. for 2 weeks with weekly blood pressure readings. Those with persistently elevated pressures (at or above the 95th percentile) underwent laboratory testing, exercise testing, and echocardiography. An age-matched group of Hispanic adolescents with blood pressure recording below the 90th percentile were also exercised. Patients were then placed on 0.1 mg clonidine b.i.d. for 12 weeks. Pretherapy exercise testing demonstrated an abnormal systolic hypertensive response (mean 193 +/- 43 mmHg) that improved after therapy (mean 167 +/- 28 mmHg). Echocardiographic data were normal. All patients had elevated levels of VLDL and triglycerides. Five patients also had HDL levels below the 50th percentile for age and sex. We conclude that this population is similar to other hypertensive adolescent populations in exercise response pre- and posttherapy with clonidine, but they demonstrated a unique clinical feature in the elevation of the VLDL and triglyceride lipoprotein fractions.
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Affiliation(s)
- I L Pina
- Division of Cardiology, University of Miami School of Medicine, Florida
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Smith EV, Janson FS. Exporting the American (information) revolution: the international impact of the National Library of Medicine. Bull Med Libr Assoc 1986; 74:339-43. [PMID: 3535952 PMCID: PMC406286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The National Library of Medicine has had an enormous impact on health information services all over the world. Although NLM is primarily a national institution, it has become an important international resource by responding to requests from the international community. NLM has been influential in three major ways. First, NLM has provided a model for other national and regional health information services. Second, it has been a catalyst, in that MEDLARS and other services it provides formed the nucleus of many regional networks. NLM helped such networks get started by giving advice on how to set up services and build collections and by "training the trainers" on the MEDLARS system. Third, NLM has supported national and regional operations by providing the additional training and materials needed for day-to-day service.
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Smith EV. Sociology. Int Psychiatry Clin 1965; 2:379-99. [PMID: 5826018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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