Review of current literature on the diagnosis and treatment of idiopathic pulmonary fibrosis

This thesis reviews the current literature on idiopathic pulmonary fibrosis (IPF), a progressive, scarring lung condition largely affecting older adults that is experiencing an increasing incidence in the U.S. and abroad. Two troubling clinical aspects of IPF are the difficulty of timely diagnosis and uncertain progression once diagnosed. The need for early detection is driven by the condition’s median survival rate post-diagnosis of about 3 years. Environmental and familial risk factors are important predictors of IPF, but cannot alone determine who is at risk for the condition. High-resolution computed tomography is currently the best non-invasive diagnostic tool, but many efforts are now underway to identify biological markers, which may aid not only in diagnosis, but illuminate both susceptibility and progression of the disease. Although the pathogenesis of IPF remains unclear, a compelling correlation has surfaced between the mechanics of IPF and herpes virus infection, which also may lead to a biological marker for the condition. Likewise, some genetic factors have shown promise in revealing pathogenesis and possible diagnosis. The only treatment currently available to ameliorate IPF is lung transplantation, but it is a last resort effort. In terms of pharmaceutical treatment, the most significant development has been the recent approval and use of two anti-fibrotic drugs, pirfenidone and nintedanib, that appear to slow the progression of the disease, but do not eliminate the fibrotic condition that impairs patients’ breathing. As efforts progress in addressing affirmative treatments for IPF, there is consensus that not enough is being done to address palliative and psychological needs of IPF. In sum, a review of the current literature suggests tremendous accomplishments have made in treating what remains a fatal condition, but much work remains to truly understand how and why IPF occurs, and whether, short of lung transplantation, there are treatments that can improve, not just maintain, patients’ health

Perspectives of youth-support professionals on encouraging healthy eating in adolescent pregnancies

Background. Nutrition during pregnancy has been identified as an important modifiable factor to reduce adverse outcomes in adolescent pregnancies. Young women are supported during their pregnancies by a variety of professionals with both clinical and non-clinical roles. Professionals with a non-clinical support role provide practical and emotional support for young women and often have longer lasting professional relationships with their clients. For this reason, this study aims to explore the perspectives of these professionals on how young women can be encouraged to improve their diet during pregnancy. Ethics. Ethical approval for this study was granted by Sheffield Hallam University Ethics Committee in July 2016. Methods. This exploratory, qualitative study recruited eight youth-support professionals to take part in semi-structured interviews. Recruitment and interviews were conducted by the lead author during February 2017, with project supervision and triangulation of data completed by the other two authors. Interviews were audio-recorded and transcribed. Interview transcripts were loaded into NVivo 11 software to facilitate analysis and emerging themes identified. Results. Five overarching themes were identified from the data: perceptions of dietary pattern; connection with baby; family and social stability; building relationships; and service availability. Youth-support professionals felt that young women encountered numerous complex barriers to eating healthily during pregnancy. Their lives are frequently chaotic and lack a stable partner and family relationships. They suggested that young women often needed specific practical support to make improvements, such as being accompanied to health appointments. There was also some concern that further cuts to services for this group would make it more difficult for vulnerable young women to access help. Conclusions. A higher level of consistent, holistic support delivered by joined-up networks of professionals is needed to help young women achieve healthier pregnancies. Further research is necessary to understand the context of young women’s lives, how this relates to their experiences of pregnancy, and what type of interventions or resources would have the biggest impact in supporting healthy behaviours

A multimodal investigation of brain health: cerebral blood flow, cognitive performance and quality of life

Understanding brain health is crucial in diagnosing, preventing and treating neurocognitive conditions (e.g., dementia). However, the literature reveals discrepancies around the interpretation of brain health and differences between populations. This thesis investigates brain health measures from different disciplines, including: resting cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) (using transcranial Doppler (TCD) ultrasound and magnetic resonance imaging (MRI)); cognition (including attention and memory); and quality of life (QoL) questionnaires. Differences between age (younger versus older) and cardiorespiratory fitness (fit versus unfit) groups were also investigated. Importantly, these multimodal brain health measures were completed in the same cohort. Declines were observed between younger and older groups in resting CBF measures (derived using TCD and MRI), and cognitive performance measures (attention-switching, learning and memory). In the older group, higher fitness offset declines in resting CBF and improved markers of cognition. In both groups, fitness significantly positively correlated with better QoL. However, no differences between age or fitness groups were observed in CVR measures. Further, CVR differed significantly depending on the imaging and analysis approach used. Future research is required to elucidate the cause of discrepancies and determine differences between groups (i.e., age/fitness/disease). Further, robust approaches to assess brain vascular health are needed

Hospital Survey on Culture of Transitions in Patient Care at a Community Hospital

Background/Purpose: The efficiency and effectiveness of patient progression through an episode of hospital care remains a concern after almost three decades of focus. Complex adaptive systems theory suggests that a hospital’s culture is a preeminent factor in the success and sustainability of large scale change and one that is often not well understood by change agents. The purpose of this study was to develop a better understanding of attitudes, beliefs, values, and practices related to transitions in patient care and to determine if any demographic variables were predictors of these key components of culture. Methods: We conducted a quantitative correlational, cross-sectional study utilizing a convenience sample. The instrument used in the study was the Hospital Survey on Culture of Transitions in Patient Care developed by M. McClelland DNP, RN, CPHQ. The instrument included a series of 23 statements using a Likert scale. All employees were invited to participate. Volunteers, students, and contracted workers were excluded from the study. Results: Sixty-one respondents answered the survey questions with a broad variability in demographics, including role, department, tenure at the hospital and years of experience. Questions were aggregated into seven domains suggested by the instrument developer with descriptive statistics to examine frequencies. Spearman correlations between demographic variables and question responses showed no significance. However, moderate to strong correlations were found in questions within each domain as expected. Additionally, correlations in many questions between do-mains were significant, most notably between the “My Unit Culture” and “Other Units Culture” do-mains. Conclusion/Recommendations: To be effective and sustainable, large scale change in hospitals relies on all affected members of the organization to implement and sustain the change to achieve the desired outcome. The study found that the attitudes, beliefs, values, and practices related to transitions in patient care are not influenced by individual roles, departments, tenure, or years of experience. Instead, this finding indicates that they are influenced by a particular organizational culture and not a culture defined by their demographics. In addition, the descriptive and correlational findings provide a baseline to better understand this hospital’s culture related to transitions in patient care for incorporation into change strategy designs

Hospital Survey on Culture of Transitions in Patient Care at a Community Hospital

Background: Delays in patient transitions of care are complex and, therefore, a reductionist model of improvement is not likely to produce sustainable results. Exploration of the culture-performance link in the organization has the potential to guide improvement methods aimed at complex, non-linear processes. Methods: An exploratory, descriptive correlational study was conducted employing the administration of the Hospital Culture of Transitions in Patient Care survey to a cross sectional convenience sample. Results: Sixty-three participants responded to the survey. In assigning a grade to transitions in the organization, 35% of participants selected a grade of “A” with 33.3% “B”, 23.3% “C”, and 8.3% “D”. In the descriptive analysis, the most favorable responses related to the Hospital Leadership and the Unit Leadership domains. The least favorable responses revealed a perception of staff delaying transfers in both the “My Unit Culture” (49.1%) and the “Other Units’ Culture” (29.8%) domains. The correlational analysis of the domains of the survey found the Hospital Leadership domain correlating significantly (p \u3c .001) with five of the other six domains. Discussion: The 65% of participants selecting grades of “B”, “C”, and “D” for organizational performance in transitions of patient care is indicative of improvement needed. The insights developed from the responses to the survey suggest it as a very relevant diagnostic tool for hospital leadership seeking to improve performance. The significant correlations of the hospital leadership domain with other domains are powerful indicators of the leveraging potential of leadership at the study site

Differences in dietary pattern by maternal age in the Born in Bradford cohort : A comparative analysis

Objective Explore associations between dietary patterns and maternal age Design Population based cohort study Setting Maternity department of a large hospital in northern England Sample Women delivering a singleton at Bradford Royal Infirmary between March 2007 and December 2010 (N = 5,083). Methods Survey data including maternal dietary patterns derived from food frequency questionnaire data using principal component analysis (PCA) were compared by maternal age using one-way ANOVA and chi-squared as appropriate. Main outcome measures Dietary pattern PCA scores, supplement use, familiarity and compliance with 5-a-day fruit and vegetable recommendations, consumption of cola, maternal BMI. Results Three distinct dietary patterns were derived from the data; snack and processed foods, meat and fish and grains and starches. Mean PCA score for snack and processed foods was higher among women aged ≤19 (0.6, CI 0.4 to 0.8) than women aged 20–34 (-0.02, CI -0.1 to 0.01) and those aged 35≥ (-0.3, CI -0.4 to -0.2). Women aged 35≥ had a significantly higher mean PCA score for the grains and starches dietary pattern (0.1, CI 0.03 to 0.3) compared to both the 20–34 years (-0.01, CI -0.05 to 0.02) and the ≤19 (-0.04, CI -0.2 to 0.1) groups. No differences were observed between groups in mean PCA scores for the meat and fish dietary pattern. Adolescent women also had higher intakes of sugar sweetened cola (0.9 cups per day, CI 0.7 to 1.1) and reported lower levels of fruit and vegetable and supplement intake. Women aged 35≥ had a higher mean BMI (28.0, CI 27.5 to 28.4) and higher prevalence of overweight (36.8%) and obesity (29.6%, p<0.001). Conclusions Significant differences were observed between age groups both in terms of diet quality and BMI. Interventions targeted by age group may be advantageous in improving maternal nutrition and contribute to healthy pregnancies

Making the best use of new technologies in the National Diet and Nutrition Survey: a review

.Background Dietary assessment is of paramount importance for public health monitoring. Currently in the UK, the population’s diets are examined by the National Diet and Nutrition Survey Rolling Programme (NDNS RP). In the survey, diet is assessed by a four-day paper-based dietary diary, with accompanying interviews, anthropometric measurements and blood and urine sampling. However, there is growing interest worldwide in the potential for new technologies to assist in data collection for assessment of dietary intake. Published literature reviews have identified the potential of new technologies to improve accuracy, reduce costs, and reduce respondent and researcher burden by automating data capture and the nutritional coding process. However, this is a fast-moving field of research, with technologies developing at a rapid pace, and an updated review of the potential application of new technologies in dietary assessment is warranted. This review was commissioned to identify the new technologies employed in dietary assessment and critically appraise their strengths and limitations in order to recommend which technologies, if any, might be suitable to develop for use in the NDNS RP and other UK population surveys. Objectives The overall aim of the project was to inform the Department of Health of the range of new technologies currently available and in development internationally that have potential to improve, complement or replace the methods used in the NDNS RP. The specific aims were: to generate an itinerary of new and emerging technologies that may be suitable; to systematically review the literature and critically appraise new technologies; and to recommend which of these new technologies, if any, would be appropriate for future use in the NDNS RP. To meet these aims, the project comprised two main facets, a literature review and qualitative research. Literature review data sources The literature review incorporated an extensive search of peer-reviewed and grey literature. The following sources were searched: Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE), Web of Science Core Collection, Ovid MEDLINE, Ovid MEDLINE In-Process, Embase, NHS EED (Economic Evaluation Database), National Cancer Institute (NCI) Dietary Assessment Calibration/Validation Register, OpenGrey, EPPI Centre (TRoPHI), conference proceedings (ICDAM 2012, ISBNPA 2013, IEEE Xplore, Nutrition Society Irish Section and Summer Meetings 2014), recent issues of journals (Journal of Medical Internet Research, International Journal of Medical Informatics), grants registries (ClinicalTrials.gov, BBSRC, report), national surveys, and mobile phone application stores. In addition, hand-searching of relevant citations was performed. The search also included solicitation of key authors in the field to enquire about Making the best use of new technologies in the NDNS: a review 4 as-yet unpublished articles or reports, and a Bristol Online Survey publicised via social media, society newsletters and meetings. Literature review eligibility criteria Records were screened for eligibility using a three-stage process. Firstly, keyword searches identified obviously irrelevant titles. Secondly, titles and abstracts were screened against the eligibility criteria, following which full-text copies of papers were obtained and, in the third stage of screening, examined against the criteria. Two independent reviewers screened each record at each stage, with discrepancies referred to a third reviewer. Eligibility criteria were pre-specified and agreed by the project Steering Group (Section 1.6). Eligible records included: studies involving technologies, new to the NDNS RP, which can be used to automate or assist the collection of food consumption data and the coding of foods and portion sizes, currently available or beta versions, public domain or commercial; studies that address the development, features, or evaluation of new technology; technologies appropriate for the requirements of the NDNS RP in terms of nutritional analysis, with capacity to collect quantifiable consumption data at the food level; primary sources of information on a particular technology; and journal articles published since the year 2000 or grey literature available from 2011 onwards. The literature search was not limited to Englishlanguage publications, which are included in the itinerary, although data were not extracted from non-English studies. Literature synthesis and appraisal New technologies were categorised into eleven types of technology, and an itinerary was generated of tools falling under each category type. Due to the volume of eligible studies identified by the literature searches, data extraction was limited to the literature focussing on selected exemplar tools of five technology categories (web-based diet diary, web-based 24- hour recall, handheld devices (personal digital assistants and mobile phones), nonautomated cameras to complement traditional methods, and non-automated cameras to replace traditional methods). For each category, at least two exemplars were chosen, and all studies involving the exemplar were included in data extraction and synthesis. Exemplars were selected on the basis of breadth of evidence available, using pre-specified criteria agreed by the Steering Group. Data were extracted by a single reviewer and an evidence summary collated for each exemplar. A quality appraisal checklist was developed to assess the quality of validation studies. The checklist was piloted and applied by two independent reviewers. Studies were not excluded on the basis of quality, but study quality was taken into account when judging the strength of evidence. Due to the heterogeneity of the literature, meta-analyses were not performed. References were managed and screened using the EPPI Reviewer 4 systematic review software. EPPI Reviewer was also used to extract data

Impact of adolescent age on maternal and neonatal outcomes in the Born in Bradford cohort

Explore associations between maternal and neonatal outcomes and maternal age, with particular reference to adolescent women. Population-based cohort study. Maternity department of a large hospital in Northern England. Primiparous women delivering a singleton at Bradford Royal Infirmary between March 2007 and December 2010 aged ≤19 years (n=640) or 20-34 years (n=3951). Subgroup analysis was performed using women aged ≤16 years (n=68). Women aged 20-34 years were used as the reference group. Maternal and neonatal outcomes. The odds of extremely low birth weight (<1000 g) were significantly higher in the adolescent group (≤19 years) compared with the reference group (adjusted OR (aOR) 4.13, 95% CI 1.41 to 12.11). The odds of very (<32 weeks) and extremely (<28 weeks) preterm delivery were also higher in the adolescent group (aOR 2.12, 95% CI 1.06 to 4.25 and aOR 5.06, 95% CI 1.23 to 20.78, respectively).Women in the adolescent group had lower odds of gestational diabetes (aOR 0.35, 95% CI 0.20 to 0.62), caesarean delivery (aOR 0.53, 95% CI 0.42 to 0.67 and instrumental delivery (aOR 0.53, 95% CI 0.41 to 0.67). This study identifies important differences in maternal and neonatal outcomes between women by age group. These findings could help in identifying at-risk groups for additional support and tailored interventions to minimise the risk of adverse outcomes for these vulnerable groups. Further work is needed to identify the causal mechanisms linking age with outcomes in adolescent women where significant gaps in the literature exist. [Abstract copyright: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health

Research into the analysis, physical properties and health effects of dietary fibre has continued steadily over the last 40-50 years. From the knowledge gained, countries have developed guidelines for their populations on the optimal amount of fibre to be consumed each day. Food composition tables from many countries now contain values for the dietary fibre content of foods, and, from these, combined with dietary surveys, population intakes have been determined. The present review assessed the uniformity of the analytical methods used, health claims permitted, recommendations and intakes, particularly from national surveys across Europe and around the world. It also assessed current knowledge on health effects of dietary fibre and related the impact of different fibre types on health. The overall intent was to be able to provide more detailed guidance on the types of fibre which should be consumed for good health, rather than simply a total intake figure, the current situation. Analysis of data indicated a fair degree of uniformity in the definition of dietary fibre, the method used for analysis, the recommended amount to be consumed and a growing literature on effects on digestive health and disease risk. However, national dietary survey data showed that intakes do not reach recommendations and very few countries provide guidance on the types of fibre that are preferable to achieve recommended intakes. Research gaps were identified and ideas suggested to provide information for more detailed advice to the public about specific food sources that should be consumed to achieve health benefits