The Influence of DASH Diet Education on Knowledge and Adherence in Primary Care: A Quality Improvement Project

Background/Local Problem: A rural family practice was concerned about the number of patients with uncontrolled hypertension, 19.86% n = 56, as defined by the Centers for Disease Control and Prevention (CDC). After several quality improvement (QI) initiates to lower the prevalence rate of uncontrolled hypertension, including proper measurement techniques and home monitoring, the modifiable risk factor of adapting one’s food intake was introduced using the Dietary Approach to Stop Hypertension (DASH) diet as an intervention. The DASH diet is an evidence-based approach for lowering blood pressure. The QI project was completed with the purpose of implementing DASH diet education and measuring patient adherence to the DASH diet. Methods: The QI project is a pre/post QI design in which the PDSA cycle was used as a framework for implementation. Interventions: Patients were educated on the DASH diet during an office visit and a follow-up telephone call three weeks later provided further support and assessment of knowledge and adherence. Results: A paired t-test was run on the pre and post-surveys demonstrated a statistically significant change (p=0.048) in knowledge and a moderately statistically significant change (p=0.076) in adherence. Conclusion: For patients with uncontrolled blood pressure in a rural family practice, education on the DASH diet and follow-up phone call, provides an opportunity to improve DASH diet knowledge and adherence. Further studies will determine if improved blood pressure is achieved in this population

A profile of the Grampian Data Safe Haven, a regional Scottish safe haven for health and population data research

Funding for DaSH is provided by the University of Aberdeen and NHS Grampian. Past and current grants from Research Data Scotland also contribute to DaSH’s funding, along with funding provided by DaSH researchers for use of the facility. The authors also acknowledge the DaSH Team (DaSH Clinical Lead Dr Shantini Paranjothy; DaSH Research Coordinators Joanne Lumsden, Vicky Munro and Diane Brown; DaSH Analysts Helen Rowlands, Adrian Martin, Jaroslaw Dymiter, and Michael Lackenby; and DaSH Information Security Manager Gary Cooper), without whom the work would not be possible.Peer reviewedPublisher PD

The Implementation of the Teach-Back Method in Dash Diet Education to Improve Blood Pressure Control in Patients with Hypertension and Low Health Literacy

Low health literacy is closely correlated with poorly-managed chronic disease conditions. Hypertension is a common chronic disease condition which can be better controlled through compliance with the dietary approaches to stop hypertension (DASH) diet; however, patients with low health literacy may have difficulty understanding the DASH diet without proper education. The teach-back method is an evidence-based education tool which can empower patients with low health literacy to better control the management of hypertension through adherence to the DASH diet. This is an evidence-based project which purposes to reveal the effectiveness of the teach-back method in providing DASH diet education in improving blood pressure control and promoting dietary compliance for patients with hypertension and low health literacy. The teach-back method was implemented into the DASH diet education in an urgent care setting which did not already have any education method in place to address health literacy. The project leader conducted a 24-hour dietary recall interview and blood pressure measurement with the participants prior to the education and eight-weeks after the education to evaluate the effect of the intervention on dietary compliance and blood pressure management. The project revealed a significant decrease in participants’ systolic blood pressure and slight decrease in diastolic blood pressure after the intervention. Additionally, participants displayed an overall increase in fruit and vegetable intake as well as a reduction in sodium intake after the intervention. The teach-back method can greatly influence patients’ dietary compliance and subsequently can improve patients’ management of chronic disease conditions such as hypertension

The barium isotopic mixture for the metal-poor subgiant star HD140283

Current theory regarding heavy element nucleosynthesis in metal-poor environments states that the r-process would be dominant. The star HD140283 has been the subject of debate after it appeared in some studies to be dominated by the s-process. We provide an independent measure of the Ba isotope mixture in HD140283 using an extremely high quality spectrum and an extensive chi^2 analysis. We exploit hyperfine splitting of the BaII 4554 \AA\ and 4934 \AA\ resonance lines in an effort to constrain the isotope ratio in 1D LTE. Using the code ATLAS in conjunction with KURUCZ06 model atmospheres we analyse 93 Fe lines to determine the star's macroturbulence. With this information we construct a grid of Ba synthetic spectra and, using a \chi^2 code, fit these to our observed data to determine the isotopic ratio, fodd, which represents the ratio of odd to even isotopes. We also analyse the Eu lines. We set a new upper limit of the rotation of HD140283 at vsin{i}\leq3.9\kms, a new upper limit on [Eu/H] < -2.80 and abundances [Fe/H] = -2.59\pm0.09, [Ba/H] = -3.46\pm0.11. This leads to a new lower limit on [Ba/Eu] > -0.66. We find that, in the framework of a 1D LTE analysis, the isotopic ratios of Ba in HD140283 indicate fodd=0.02\pm0.06, a purely s-process signature. This implies that observations and analysis do not validate currently accepted theory. We speculate that a 1D code, due to simplifying assumptions, is not adequate when dealing with observations with high levels of resolution and S/N because of the turbulent motions associated with a 3D stellar atmosphere. New approaches to analysing isotopic ratios, in particular 3D hydrodynamics, need to be considered when dealing with the levels of detail required to properly determine them. However published 3D results exacerbate the disagreement between theory and observation.Comment: 16 pages, 10 figures, 7 tables, 1 online appendix Accepted by A&

Minimal important change and other measurement properties of the Oxford Elbow Score and the Quick Disabilities of the Arm, Shoulder, and Hand in patients with a simple elbow dislocation

Study design: Validation study using data from a multicenter, randomized, clinical trial (RCT). Objectives: To evaluate the reliability, validity, responsiveness, and minimal important change (MIC) of the Dutch version of the Oxford Elbow Score (OES) and the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) in patients with a simple elbow dislocation. Background: Patient-reported outcome measures are increasingly important for assessing outcome following elbow injuries, both in daily practice and in clinical research. However measurement properties of the OES and Quick-DASH in these patients are not fully known. Methods: OES and Quick-DASH were completed four times until one year after trauma. Mayo Elbow Performance Index, pain (VAS), Short Form-36, and EuroQol-5D were completed for comparison. Data of a multicenter RCT (n = 100) were used. Internal consistency was determined using Cronbach’s alpha. Construct and longitudinal validity were assessed by determining hypothesized strength of correlation between scores or changes in scores, respectively, of (sub)scales. Finally, floor and ceiling effects, MIC, and smallest detectable change (SDC) were determined. Results: OES and Quick-DASH demonstrated adequate internal consistency (Cronbach α, 0.882 and 0.886, respectively). Construct validity and longitudinal validity of both scales were supported by >75% correctly hypothesized correlations. MIC and SDC were 8.2 and 12.0 point for OES, respectively. For Quick-DASH, these values were 11.7 and 25.0, respectively. Conclusions: OES and Quick-DASH are reliable, valid, and responsive instruments for evaluating elbow-related quality of life. The anchor-based MIC was 8.2 points for OES and 11.7 for QuickDASH

Pilot's Automated Weather Support System (PAWSS) concepts demonstration project. Phase 1: Pilot's weather information requirements and implications for weather data systems design

The weather information requirements for pilots and the deficiencies of the current aviation weather support system in meeting these requirements are defined. As the amount of data available to pilots increases significantly in the near future, expert system technology will be needed to assist pilots in assimilating that information. Some other desirable characteristics of an automation-assisted system for weather data acquisition, dissemination, and assimilation are also described

Dietary Sodium and Hypertension Status: A Quantitative Study Exploring Older Adults’ Food Purchasing and Consumption Behaviour

Objectives: The purpose of the study was to investigate the relation between hypertension (HTN) status and the amount of sodium purchased and consumed by community dwelling older adults. The secondary objective was to compare their accordance with the DASH dietary pattern according to hypertension status. Method: A dietary survey of 30 community dwelling older adults was conducted. The amount of daily sodium purchased and consumed, DASH score and DASH accordance were compared between the hypertensive and normotensive older adults using grocery receipts and 24-hour dietary recall. Participants’ knowledge, concern and behaviour regarding dietary sodium were also assessed using a researcher administered study questionnaire. Result: There was no significant difference in both the amount of sodium purchased (p = 0.07) and consumed (p = 0.61) by the older adults with and without hypertension. Older adults with HTN had significantly lower DASH scores (DASH score = 1.8) than those without HTN (DASH score = 4.3) (p \u3c 0.001), with only 6.3% of HTN adults considered as DASH accordant. Participants’ knowledge and concern regarding dietary sodium did not show any meaningful relationship with the amount of sodium purchased and consumed. Conclusion: This study implied a need for more established guidelines regarding reduction of sodium content of processed, pre-packaged and restaurants foods in the Canadian food supply. The need for more involvement of health professionals regarding dietary modification to prevent and manage hypertension in addition to greater public health efforts is also apparent from the findings of the study

On optimizing over lift-and-project closures

The lift-and-project closure is the relaxation obtained by computing all lift-and-project cuts from the initial formulation of a mixed integer linear program or equivalently by computing all mixed integer Gomory cuts read from all tableau's corresponding to feasible and infeasible bases. In this paper, we present an algorithm for approximating the value of the lift-and-project closure. The originality of our method is that it is based on a very simple cut generation linear programming problem which is obtained from the original linear relaxation by simply modifying the bounds on the variables and constraints. This separation LP can also be seen as the dual of the cut generation LP used in disjunctive programming procedures with a particular normalization. We study some properties of this separation LP in particular relating it to the equivalence between lift-and-project cuts and Gomory cuts shown by Balas and Perregaard. Finally, we present some computational experiments and comparisons with recent related works