Dietetics, Nutrition and Biological Sciences
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Item 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, RussellItem Functional interplay between platelet activation and endothelial dysfunction in patients with coronary heart disease(Taylor & Francis, 2006-05) Davidson, Isobel; Robinson, S. D.; Harding, S. A.; Cummins, P.; Din, J. N.; Sarma, J.; Fox, K. A. A.; Boon, N. A.; Newby, D. E.Platelet-monocyte binding and surface P-selectin expression are sensitive markers of platelet activation. Endothelium-derived factors are known to inhibit platelet activation and may confer important anti-atherothrombotic effects. We assessed the relationship between platelet activation and endothelium-dependent vasomotion in patients with coronary heart disease (CHD). Twenty male patients with stable CHD were compared with 20 healthy men. Platelet-monocyte binding and platelet surface expression of P-selectin were assessed using two-colour flow cytometry on whole blood. Forearm blood flow was assessed in patients using venous occlusion plethysmography during intra-arterial infusions of substance P, acetylcholine and sodium nitroprusside. Platelet activation was higher in patients than healthy men (platelet-monocyte binding, 27--3 vs. 20--1%; P-<-0.05). In patients with CHD, there was an inverse correlation between maximal substance P induced vasodilatation and both platelet-monocyte binding (P-=-0.003) and P-selectin expression (P-=-0.02). A similar correlation was observed between platelet-monocyte binding and the vasomotor response to acetylcholine (P-=-0.08) but not with sodium nitroprusside. In patients with stable coronary heart disease, there is a strong inverse relationship between markers of platelet activation and endothelium-dependent vasomotor function. This may explain the pathophysiological mechanism linking endothelial vasomotor dysfunction and the risk of acute atherothrombotic events.Item Prenatal programming of postnatal obesity: fetal nutrition and the regulation of leptin synthesis and secretion before birth(Cambridge University Press, 2004-08) Davidson, Isobel; Smith, SaraThe introduction of the process of nutritional screening into clinical standards has been driven by the increasing awareness of the prevalence of undernutrition in acute and primary care, along with its associated morbidity and mortality. However, the increasing prevalence of obesity in the general population suggests that an increased number of patients admitted to hospital will be obese. Increased morbidity has also been reported in the injured obese patient and may be associated with poor nutritional support. This situation may occur because the profound metabolic disturbances accompanying trauma in this group are not recognised, and subsequent feeding practices are inappropriate. Screening tools currently classify patients by using simple markers of assessment at the whole-body level, such as BMI. Subsequently, patients are identified as at risk only if they are undernourished. Such comparisons would by definition classify injured obese patients as at minimal or no nutritional risk, and they would therefore be less likely to be re-screened. This approach could result in potential increases in morbidity, length of rehabilitation and consequent length of hospital stay. It is likely that the identification of potential risk in obese injured patients goes beyond the measurement of such indices as BMI and percentage weight loss, which are currently utilised by the majority of screening processes.Item Habitual levels and patterns of physical activity in a Scottish haemodialysis population, and their relationship with markers of function and functional capacity(2014-05) Smith, Sara; Rayson, P.; Goddard, J.; Davidson, IsobelItem Potential of Nutraceuticals against Obesity Complications(CRC Press, 2013) Conroy, Kylie; Davidson, Isobel; Warnock, Mary; Mahabir, Somdat; Pathak, YashwantObesity has been regarded as a disease by the World Health Organisation (WHO) since its inception in 1948; however, it was not deemed a public health problem by WHO until 1997 (James 2008). The most widely used method of classifying overweight and obesity is by body mass index (BMI = weight/ height2), and those with a BMI of 25-29.99 kg/m2 are classified as overweight and those with a BMI of ≥30 kg/m2 as obese (WHO 2011). However, although BMI correlates with body fat it is not a direct measure and results may be skewed by a high muscle mass such as can be seen in some athletes.Item 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.Item Validation of new mobile phone dietary assessment tool DietPhone against diet diaries and urinary nitrogen(Nutrition Society, 2010-11-19) Monaghan, L.; Paget, A.; Young, D.; Aitchison, Ken; Davidson, Isobel; Clapham, MichaelItem 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.Item The use of a physical training programme to improve quality of life, nutritional and functional parameters in long term haemodialysis patients(2006) Smith, Sara; Davidson, Isobel; Creig, C.; Chalmers, K.; Jenkins, D. A. S.Item Validity of nutritional assessment methods in long term haemodialysis patients(Cambridge University Press, 2005) Smith, Sara; Davidson, Isobel; Jenkins, D. A. S.