Establishing an evidenced-based dietetic model of care in haemodialysis using implementation science

To establish an evidence-based dietetics service in an in-centre haemodialysis unit utilising implementation science.The service was developed through the Knowledge-to-Action Framework. The steps of the Action Cycle were addressed through a literature review, identification of evidence-based guidelines, benchmarking and local staff engagement. The theoretical domains framework (TDF) was used to identify barriers/enablers, and behaviour change wheel to determine appropriate interventions. To monitor, evaluate outcomes and assess sustained knowledge use we employed multidisciplinary team engagement and database use. Audit data were collected at baseline, 6 and 12 months on nutrition assessment (Patient-Generated Subjective Global Assessment), intervention timeliness and alignment to dietetic workforce recommendations. Descriptive statistics, McNemar tests and a linear mixed model were applied.Barriers existed in the knowledge, skills, environmental context and resources TDF domains. Suitable interventions were identified with training on nutritional management of haemodialysis patients delivered to 148 nurses, and nutrition management recommendations summarised into local procedural resources. A database to prompt and monitor outcome measures was created and indicated that over 18 months post-service commencement, eligible patients received nutrition assessment at least 6-monthly, aligning with recommendations. Prevalence of malnutrition was 28% (n = 9/32) at baseline, 23% (n = 5/22) at 6 months and 20% (n = 4/20) at 12 months (P = 0.50).We demonstrated benefits to service development and implementation with implementation science providing a structured and methodical approach to translating guidelines into practice. Development of training, resources and prompts for outcome measures has supported the establishment of an evidence-based dietetics service in a haemodialysis unit

Liver transplant recipients’ experiences and perspectives of a telehealth-delivered lifestyle programme A qualitative study

Introduction Dietary modification and exercise are encouraged to address cardiometabolic risk factors after solid organ transplantation. However, the lived experience of attempting positive lifestyle changes for liver transplant recipients is not known. The aim of this study was to explore the experiences of liver transplant recipients and their perspectives of a 12-week telehealth lifestyle programme and assess the feasibility of this innovative health service. Methods Focus groups and one-on-one interviews were conducted with participants who had completed a 12-week, group-based, telehealth-delivered diet and exercise programme and thematic qualitative analysis was used to code and theme the data. Results In total, 19 liver transplant recipients participated in the study (25-68 years, median time since transplant 4.4 years, 63% male). Overarching themes included: (a) 'broad telehealth advantages' which highlighted that telehealth reduced the perceived burdens of face-to-face care; (b) 'impact of employment' which identified employment as a competing priority and appeared to effect involvement with the programme; (c) 'adapting Mediterranean eating pattern to meet individual needs' which identified the adaptability of the Mediterranean diet supported by sessions with the dietitian; (d) 'increasing exercise confidence' which recognised that a tailored approach facilitated confidence and acceptability of the exercise component of the programme. Discussion A telehealth lifestyle programme delivered by dietitians and exercise physiologists is an acceptable alternative to face-to-face care that can meet the needs of liver transplant recipients. There is a need to further innovate and broaden the scope of routine service delivery beyond face-to-face consultations

Fieldwork Educators\u27 Perspectives: Professional Behavior Attributes of Level II Fieldwork Students

A review of the literature revealed a lack of consistent expectations for professional behaviors required of level II fieldwork students. This study sought to obtain a consensus of perspectives of level II fieldwork educators by asking, “What are the essential professional behavior attributes for level II fieldwork students?” Delphi methodology was used to collect data in two rounds of surveys. In the first, 49 fieldwork educators listed professional behavior attributes they believed to be important for fieldwork students. The data was synthesized into themes for distribution in the second survey, which were identified as essential, non-essential, or site-specific by 53 participants. The 218 different professional behavior attributes provided by Survey 1 respondents were categorized into 22 attribute themes. In Survey 2, 20 of the 22 attribute themes reached a consensus level of at least 75% and five reached 100% agreement. These results show a current perspective of what fieldwork educators value in level II fieldwork students and may be informative to occupational therapy faculty, students, and fieldwork educators

Excess gestational weight gain : an exploration of midwives\u27 views and practice.

BackgroundExcess gestational weight gain (GWG) can affect the immediate and long term health outcomes of mother and infant. Understanding health providers\u27 views, attitudes and practices around GWG is crucial to assist in the development of practical, time efficient and cost effective ways of supporting health providers to promote healthy GWGs. This study aimed to explore midwives\u27 views, attitudes and approaches to the assessment, management and promotion of healthy GWG and to investigate their views on optimal interventions. MethodsMidwives working in antenatal care were recruited from one rural and one urban Australian maternity hospital employing purposive sampling strategies to assess a range of practice areas. Face-to-face interviews were conducted with 15 experienced midwives using an interview guide and all interviews were digitally recorded, transcribed verbatim and analysed thematically. ResultsMidwives interviewed exhibited a range of views, attitudes and practices related to GWG. Three dominant themes emerged. Overall GWG was given low priority for midwives working in the antenatal care service in both hospitals. In addition, the midwives were deeply concerned for the physical and psychological health of pregnant women and worried about perceived negative impacts of discussion about weight and related interventions with women. Finally, the midwives saw themselves as central in providing lifestyle behaviour education to pregnant women and identified opportunities for support to promote healthy GWG. ConclusionsThe findings indicate that planning and implementation of healthy GWG interventions are likely to be challenging because the factors impacting on midwives\u27 engagement in the GWG arena are varied and complex. This study provides insights for guideline and intervention development for the promotion of healthy GWG. <br /

Biogenic non-crystalline U (IV) revealed as major component in uranium ore deposits

Historically, it is believed that crystalline uraninite, produced via the abiotic reduction of hexavalent uranium (U (VI)) is the dominant reduced U species formed in low-temperature uranium roll-front ore deposits. Here we show that non-crystalline U (IV) generated through biologically mediated U (VI) reduction is the predominant U (IV) species in an undisturbed U roll-front ore deposit in Wyoming, USA. Characterization of U species revealed that the majority (-1/458-89%) of U is bound as U (IV) to C-containing organic functional groups or inorganic carbonate, while uraninite and U (VI) represent only minor components. The uranium deposit exhibited mostly 238 U-enriched isotope signatures, consistent with largely biotic reduction of U (VI) to U (IV). This finding implies that biogenic processes are more important to uranium ore genesis than previously understood. The predominance of a relatively labile form of U (IV) also provides an opportunity for a more economical and environmentally benign mining process, as well as the design of more effective post-mining restoration strategies and human health-risk assessment.University of Wyomin

Views of women and health professionals on mHealth lifestyle interventions in pregnancy: a qualitative investigation

BACKGROUND: Evidence suggests that women are failing to meet guidelines for nutrition, physical activity, and weight gain during pregnancy. Interventions to promote a healthy lifestyle in pregnancy demonstrate mixed results and many are time and resource intensive. mHealth-delivered interventions offer an opportunity to provide trusted source information in a timely and cost-effective manner. Studies regarding women\u27s and health professionals\u27 views of mHealth in antenatal care are limited. OBJECTIVE: This study aimed to explore women\u27s and health professionals\u27 views regarding mHealth information sources and interventions to assist women to eat well, be physically active, and gain healthy amounts of weight in pregnancy. METHODS: A descriptive qualitative research approach employed focus groups and in-depth interviews with 15 pregnant or postpartum women and 12 in-depth interviews with health professionals including two from each category: obstetricians, general practitioners, midwives, dietitians, physiotherapists, and community pharmacists. All interviews were transcribed verbatim and thematically analyzed. RESULTS: Women uniformly embraced the concept of mHealth information sources and interventions in antenatal care and saw them as central to information acquisition and ideally incorporated into future antenatal care processes. Health professionals exhibited varied views perceiving mHealth as an inevitable, often parallel, service rather than one integrated into the care model. Four key themes emerged: engagement, risk perception, responsibility, and functionality. Women saw their ability to access mHealth elements as a way to self-manage or control information acquisition that was unavailable in traditional care models and information sources. The emergence of technology was perceived by some health professionals to have shifted control of information from trusted sources, such as health professionals and health organizations, to nontrusted sources. Some health professionals were concerned about the medicolegal risks of mHealth (incorrect or harmful information and privacy concerns), while others acknowledged that mHealth was feasible if inherent risks were addressed. Across both groups, there was uncertainty as to who should be responsible for ensuring high-quality mHealth. The absence of a key pregnancy or women\u27s advocacy group, lack of health funds for technologies, and the perceived inability of maternity hospitals to embrace technology were seen to be key barriers to provision. Women consistently identified the functionality of mHealth as adding value to antenatal care models. For some health professionals, lack of familiarity with and fear of mHealth limited their engagement with and comprehension of the capacity of new technologies to support antenatal care. CONCLUSIONS: Women exhibited positive views regarding mHealth for the promotion of a healthy lifestyle in antenatal care. Conversely, health professionals expressed a much wider variation in attitudes and were more able to identify potential risks and barriers to development and implementation. This study contributes to the understanding of the opportunities and challenges in developing mHealth lifestyle interventions in antenatal care

Gestational weight gain information: seeking and sources among pregnant women

BACKGROUND: Promoting healthy gestational weight gain (GWG) is important for preventing obstetric and perinatal morbidity, along with obesity in both mother and child. Provision of GWG guidelines by health professionals predicts women meeting GWG guidelines. Research concerning women\u27s GWG information sources is limited. This study assessed pregnant women\u27s sources of GWG information and how, where and which women seek GWG information. METHODS: Consecutive women (n&thinsp;=&thinsp;1032) received a mailed questionnaire after their first antenatal visit to a public maternity hospital in Melbourne, Australia. Recalled provision of GWG guidelines by doctors and midwives, recalled provided GWG goals, and the obtaining of GWG information and information sources were assessed. RESULTS: Participants (n&thinsp;=&thinsp;368; 35.7&nbsp;% response) averaged 32.5&nbsp;years of age and 20.8&nbsp;weeks gestation, with 33.7&nbsp;% speaking a language other than English. One in ten women recalled receiving GWG guidelines from doctors or midwives, of which half were consistent with Institute of Medicine guidelines. More than half the women (55.4&nbsp;%) had actively sought GWG information. Nulliparous (OR 7.07, 95&nbsp;% CI&thinsp;=&thinsp;3.91-12.81) and obese (OR 1.96, 95&nbsp;% CI&thinsp;=&thinsp;1.05-3.65) women were more likely to seek information. Underweight (OR 0.29, 95&nbsp;% CI&thinsp;=&thinsp;0.09-0.97) women and those working part time (OR 0.52, 95&nbsp;% CI&thinsp;=&thinsp;0.28-0.97) were less likely to seek information. Most frequently reported GWG sources included the internet (82.7&nbsp;%), books (55.4&nbsp;%) and friends (51.5&nbsp;%). The single most important sources were identified as the internet (32.8&nbsp;%), general practitioners (16.9&nbsp;%) and books (14.9&nbsp;%). CONCLUSION: More than half of women were seeking GWG guidance and were more likely to consult non-clinician sources. The small numbers given GWG targets, and the dominance of non-clinical information sources, reinforces that an important opportunity to provide evidence based advice and guidance in the antenatal care setting is currently being missed