Browsing by Person "Richardson, Rosemary A."

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Nutritional demands in acute and chronic illness
(Cambridge University Press, 2003-11) Davidson, Isobel; Richardson, Rosemary A.
Common to both acute and chronic disease are disturbances in energy homeostasis, which are evidenced by quantitative and qualitative changes in dietary intake and increased energy expenditure. Negative energy balance results in loss of fat and lean tissue. The management of patients with metabolically-active disease appears to be simple; it would involve the provision of sufficient energy to promote tissue accretion. However, two fundamental issues serve to prevent nutritional demands in disease being met. The determination of appropriate energy requirements relies on predictive formulae. While equations have been developed for critically-ill populations, accurate energy prescribing in the acute setting is uncommon. Only 25-32% of the patients have energy intakes within 10% of their requirements. Clearly, the variation in energy expenditure has led to difficulties in accurately defining the energy needs of the individual. Second, the acute inflammatory response initiated by the host can have profound effects on ingestive behaviour, but this area is poorly understood by practising clinicians. For example, nutritional targets have been set for specific disease states, i.e. pancreatitis 105-147 KJ (25-35 kcal)/kg; chronic liver disease 147-168 kj (35-40 kcl)/kg, but given the alterations in gut physiology that accompany the acute-phase response, targets are unlikely to be met. In cancer cachexia attenuation of the inflammatory response using eicosapentaenoic acid results in improved nutritional intake and status. This strategy poses an attractive proposition in the quest to define nutritional support as a clinically-effective treatment modality in other disorders.
Nutritional status of elective gastrointestinal surgery patients pre- and post-operatively
(Elsevier, 2002-06) Davidson, Isobel; Fettes, Sheila; Richardson, Rosemary A.; Pennington, Christopher
Background and Aims: Studies have indicated that undernutrition is common on admission to hospital but there is limited data on change in nutritional parameters during the hospital stay. We assessed the nutritional status of elective gastrointestinal surgery patients on admission and documented change in nutritional indices during hospitalisation.Methods: Two hundred patients aged 18-80 years undergoing elective open gastrointestinal surgery were nutritionally assessed on admission and 150 were reassessed on commencement of oral diet post-surgery. Data were collected on height, weight, upper arm anthropometry and hand-grip dynamometry. Results: On admission BMI <20, 20-24.9 and >25, respectively, were found in 9%, 34% and 57% of patients. Post-surgery, 34% of patients experienced a clinically significant weight loss. Males lost significantly more weight (3.7% vs 1.6%, P<0.001) and tended to lose muscle mass while females preferentially lost subcutaneous fat. Conclusions: The incidence of undernutrition on admission appears to be lower than previously reported. However, clinically significant weight loss was common and this study highlighted gender differences in the changes in nutritional parameters experienced by gastrointestinal surgery patients. This differential influence of gender warrants further investigation and may have implications for the nutritional management of such patients.
Self-management in palliative medicine
(Ovid Technologies, 2012-12) Davidson, Isobel; Whyte, F.; Richardson, Rosemary A.
Purpose of review: Self-management in the palliative care domain means equipping patients and carers to manage medical aspects of illness, managing life roles and allowing adaptation to the changing dynamics brought on by illness and its progression. As well as dealing with the psychological consequences of living with a life-threatening illness in which the aim is to optimise living. This review will consider the rationale for developing and adopting self-management as a model of care. Recent findings: Health policy currently advocates de-investment in traditional approaches to patient management paralleled with a re-engineering of services towards approaches required to underpin self-management care. However, the literature suggests that patients lack a fundamental knowledge and more importantly an understanding of the progression of their illness or what palliative of hospice care is. As a first step, this issue must be addressed in any self-management intervention. In terms of outcomes evidence continues to emerge that when compared with care self-management imparts sustainable understanding in targeted areas and has the potential to create a preventive spend environment. Summary: The role of self-management in palliative care requires further elucidation yet based on the evidence which is predominately gleaned from long-term conditions it would seem sensible if not ethical to educate patients/carers to actively be involved in decision making.
The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively : a randomised clinical trial
(Elsevier, 2005-02) Davidson, Isobel; Richardson, Rosemary A.; Yuill, K. A.; Garde, O. J.; Parks, R. W.
Aim: Recent evidence suggests that the provision of energy-containing fluids is safe and may impact positively on markers of recovery. The aims of this study were to assess the tolerance of preoperative carbohydrate fluid administration and to determine its effect on postoperative metabolic and clinical responses. Methods: Patients admitted to the Royal Infirmary of Edinburgh for major, elective abdominal surgery were recruited to this double-blind, randomised study and received either a placebo drink or carbohydrate (12.6 g/100 ml) drink (CHOD). Patients consumed 800 ml of their drink on the evening before surgery and 400 ml on the day of surgery 2-3 h before the induction of anaesthesia. Nutritional status was determined using body mass index (BMI) and upper arm anthropometry; all measurements were taken preoperatively, postoperatively and at discharge. Blood glucose and insulin concentrations were also measured preoperatively and on the first post operative day. Length of hospital stay (LOS) and postoperative complications were recorded. Results: Seventy-two patients were recruited and 65 (34 male:31 female) completed this study. Thirty-four patients were randomised to receive the placebo drink (control group) and 31 patients to receive the carbohydrate drink (CHOD group). Groups were well-matched in terms of gender and age. There were no differences between the two groups at baseline for BMI (control: -25.11.7 kg/m2; CHOD -25.21.2 kg/m2), upper arm anthropometry or surgical procedure. At discharge loss of muscle mass (arm muscle circumference) was significantly greater in the control group when compared with the CHOD group (control: -1.10.15 cm; CHOD: -0.50.16 cm; P<0.05). Baseline insulin (control: 20.74.9mU/l; CHOD: 24.66.2mU/l) and glucose (control: 6.01.4 mmol/l; CHOD 5.71.4 mmol/l) were comparable in the two groups and did not differ postoperatively. No complications were recorded as a result of preoperative fluid consumption. Postoperative morbidity occurred in six patients from each group. Median LOS in the control group was 10 days (IQR=6), and 8 days (IQR=4) in the CHOD group. Conclusion: Preoperative consumption of carbohydrate-containing fluids is safe. Provision of a carbohydrate energy source prior to surgery may attenuate depletion of muscle mass after surgery. Further studies are required to determine if this preservation of muscle mass is reflected in improved function and reduced rehabilitation time.
The contribution of the dietitian and nutritionist to palliative medicine
(Oxford University Press, 2009-10-29) Richardson, Rosemary A.; Davidson, Isobel; Cherney, N.; Christakis, N.; Fallon, M.; Hanks, G.; Kaasa, S.; Portenoy, R.
Nutritional management of patients receiving palliative care has not, until recently, been considered an explicit element of care( 1 ). The features of cachexia such as anorexia are often considered by health-care professionals as milestones of disease progression. Traditionally, the input from palliative care specialists relating to nutrition is one of ethics and centres on the withdrawal of food and fluids. Nevertheless, many patients present with and are distressed by the presence of symptoms that affect their ability to eat 'normally' i.e. dysphagia, taste changes, xerostomia, and dementia. The deterioration and alteration in nutritional intake which results promotes weight loss, is accompanied by fatigue and often a distressing alteration in body image. The futility of approaches that merely seek to improve patients' nutritional intake (either enterally or parenterally) and replete body mass has redirected the focus of nutritional intervention to maintenance and symptom control. (see Chapter 10.3.2) Our improved understanding of the metabolic sequelae of disease and an appreciation of nutritional strategies that may be used to ameliorate or manage symptoms (see Table 4.7.1) has resulted in the recognition of nutrition as a component of holistic palliative care. Embedding nutritional care in palliative medicine must be paralleled by formal and rigorous evaluation (i.e. randomized controlled trials) ofpractice. To a large part this remains to be addressed and it would be nave not to appreciate the inherent difficulties of conducting nutritional research in the palliative-care environment. The challenge for practitioners is to strike a balance between the application of research evidence with the practical nutritional needs of the individual.
The contribution of the dietitian and nutritionist to palliative medicine
(Oxford University Press, 2015) Richardson, Rosemary A.; Davidson, Isobel; Cherny, Nathan; Currow, David; Fallon, Marie; Kaasa, Stein; Portenoy, Russell