Variances of dietary preparation for suppression of physiological 18F-FDG myocardial uptake in the presence of cardiac sarcoidosis: a systematic review

Background: F-fluorodeoxyglucose (F-FDG) positron emission tomography (PET) is used in the diagnosis and management of patients with cardiac sarcoidosis (CS). Various preparation protocols have been proposed to minimise myocardial F-FDG uptake and improve scan readability. The aim of this systematic review was to identify the optimal dietary prescription for suppression of physiological F-FDG myocardial uptake to enhance clinical diagnosis of CS. Methods and Results: MEDLINE and PubMed databases identified 13 studies meeting inclusion criteria for review. Articles were assessed using the Australian National Health and Medical Research Council levels of evidence and categorised as sarcoidosis (human) or non-sarcoidosis (human, animal). Visual uptake scales (qualitative) and/or standardised uptake values (SUV) (quantitative) were used in all the studies reviewed. Nine of 11 human studies showed statistically significant improvements in PET scan interpretation with carbohydrate-restricted diets compared with fasting only, and when carbohydrates were restricted for a longer period of time. Two animal studies showed statistically significant improvements following very low carbohydrate diet preparation (0.01% and 0.4% carbohydrate diets) compared with higher carbohydrate diets. Conclusions: Variation in measures used, dietary prescriptions, fasting times, species and study quality makes result comparison and applicability difficult. Definitive dietary recommendations are not possible based on current evidence

Food avoidance in outpatients with Inflammatory Bowel Disease – Who, what and why

Background and aims: Food avoidance is common with Inflammatory Bowel Disease (IBD) and adherence to dietary guidelines is poor, contributing to under and over nutrition. Reasons for food avoidance have not been previously explored in detail. This study of IBD outpatients aimed to describe food avoidance patterns and rationale behind this, and describe source and confidence with dietary advice. Methods: A prospective cross-sectional study using structured interview, nutritional assessment and medical record review was conducted in patients with confirmed diagnosis of IBD (n = 117) attending outpatient clinics over a six-month period. Participants were interviewed on foods avoided, rationale for food avoidance and previous dietary advice (source and confidence). Means ± SD or medians (IQR), percentages and counts were used to describe participant characteristics, food avoidance, and source and confidence in dietary advice. Bivariate analysis was used to explore relationships between food avoidance and disease factors (IBD subtype; disease activity: active disease vs remission), and between confidence in dietary advice and disease activity. Results: Almost all participants reported food avoidance (90%), with more foods avoided during active disease (5.2 ± 3.6 foods/food categories, versus remission 2.9 ± 2.5, p < 0.001). Lactose-containing foods were avoided by 40% of patients in active disease and 33% in remission. Pain/cramping, increased bowel motions and diarrhea were the most common reasons for avoiding foods/food categories during both active disease and remission. Participants were most confident in advice received from the internet (3.3 ± 1.2; dietitian: 2.8 ± 1.5) in active disease; in remission participants had greatest confidence in advice received from gastroenterologists (4.1 ± 0.8; dietitian: 3.5 ± 1.2). Conclusion: High prevalence of avoidance of nutritious foods and low confidence in dietetic advice amongst people with IBD is of concern. Further work is needed to build trust and ensure patients are provided with evidence-based nutrition recommendations to manage their symptoms whilst optimizing nutritional quality of their diet

A qualitative exploration of factors influencing medical staffs’ decision-making around nutrition prescription after colorectal surgery

Background: Enhanced Recovery After Surgery (ERAS) guidelines recommend early oral feeding with nutritionally adequate diets after surgery. However, studies have demonstrated variations in practice and poor adherence to these recommendations among patients who have undergone colorectal surgery. Given doctors are responsible for prescribing patients’ diets after surgery, this study explored factors which influenced medical staffs’ decision-making regarding postoperative nutrition prescription to identify potential behaviour change interventions. Methods: This qualitative study involved one-on-one, semi-structured interviews with medical staff involved in prescribing nutrition for patients following colorectal surgery across two tertiary teaching hospitals. Purposive sampling was used to recruit participants with varying years of clinical experience. The Theoretical Domains Framework (TDF) underpinned the development of a semi-structured interview guide. Interviews were audio recorded, with data transcribed verbatim before being thematically analysed. Emergent themes and sub-themes were discussed by all investigators to ensure consensus of interpretation. Results: Twenty-one medical staff were interviewed, including nine consultants, three fellows, four surgical trainees and five junior medical doctors. Three overarching themes emerged from the data: (i) Prescription preferences are influenced by perceptions, experience and training; (ii) Modifying prescription practices to align with patient-related factors; and (iii) Peers influence prescription behaviours and attitudes towards nutrition. Conclusions: Individual beliefs, patient-related factors and the social influence of peers (particularly seniors) appeared to strongly influence medical staffs’ decision-making regarding postoperative nutrition prescription. As such, a multi-faceted approach to behaviour change is required to target individual and organisational barriers to enacting evidence-based feeding recommendations

Towards a voice inclusive school culture: Multi-stakeholder reflections

In 2018 and 2019, a large secondary school in south east Queensland committed to placing students, their views and perspectives, at the centre of wellbeing provision. They did this by participating in the Wellbeing Matters project, led by Dr Jenna Gillett-Swan and Professor Linda Graham from QUT’s Faculty of Education, and funded by the Queensland Government’s Education Horizon Grant Scheme. In this project, students were positioned as being at the centre of wellbeing decision-making processes

Early oral feeding after colorectal surgery: a mixed methods study of knowledge translation

Aim: Evidence-based guidelines recommend early oral feeding (EOF) as prescription of an unrestricted diet within 24 hours after colorectal surgery. The present study aimed to understand local postoperative feeding practices after colorectal surgery; identify barriers to EOF implementation; select, tailor and implement stakeholder engagement strategies to facilitate EOF uptake; and evaluate changes to practice. Methods: A longitudinal, mixed methods study was undertaken, guided by the knowledge-to-action framework. Phase 1 assessed the nature of the problem using postoperative diet Audits 1 and 2. In Phase 2, staff interviews identified barriers to EOF implementation. Results from Phases 1 and 2 were fed back to inform Phase 3 strategies. Knowledge uptake was monitored in Audits 3 and 4. Phase 4 evaluated outcomes from Audit 5. Results: In Phase 1, median time to commencement of full diet was postoperative Days 4 and 3 in Audits 1 and 2, respectively. Phase 2 identified EOF barriers, including disparities in diet upgrade practices and variable understanding of hospital diets. In Phase 3, planned strategies were implemented to improve EOF (i) educational session describing local hospital diets; (ii) consultant decision to prescribe a full diet on operation notes; and (iii) educational sessions with nursing staff describing changes to EOF practice. In Phase 4, median time to commencement of full diet improved to postoperative Day 0. Patients prescribed a full diet on operation notes increased from 0% to 82%. Conclusions: The present study successfully identified and overcame local barriers to improve EOF practices to align with guideline recommendations

GMP synthase is required for virulence factor production and infection by cryptococcus neoformans

Over the last four decades the HIV pandemic and advances in medical treatments that also cause immunosuppression have produced an ever-growing cohort of individuals susceptible to opportunistic pathogens. Of these, AIDS patients are particularly vulnerable to infection by the encapsulated yeast Cryptococcus neoformans. Most commonly found in the environment in purine-rich bird guano, C. neoformans experiences a drastic change in nutrient availability during host infection, ultimately disseminating to colonize the purine-poor central nervous system. Investigating the consequences of this challenge, we have characterized C. neoformans GMP synthase, the second enzyme in the guanylate branch of de novo purine biosynthesis. We show that in the absence of GMP synthase, C. neoformans becomes a guanine auxotroph, the production of key virulence factors is compromised, and the ability to infect nematodes and mice is abolished. Activity assays performed using recombinant protein unveiled differences in substrate binding between the C. neoformans and human enzymes, with structural insights into these kinetic differences acquired via homology modeling. Collectively, these data highlight the potential of GMP synthase to be exploited in the development of new therapeutic agents for the treatment of disseminated, life-threatening fungal infections