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Taylor LM, Tandon P, Raman M. Using a Patient-Completed Food Frequency Questionnaire to Determine Mediterranean Diet Score in People with Inflammatory Bowel Disease. CAN J DIET PRACT RES 2023; 84:247-250. [PMID: 37265086 DOI: 10.3148/cjdpr-2023-005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Purpose: To examine the level of agreement between a patient-completed food frequency questionnaire (FFQ) and assessment of usual intake by a registered dietitian (RD) to score adherence to a Mediterranean diet (MedD) in patients with inflammatory bowel disease (IBD).Methods: Patients with IBD completed a short FFQ and were subsequently interviewed by an RD. A 12-item MedD score (MDS), adapted from the Mediterranean Diet Adherence Screener (MEDAS), was calculated from the FFQ and RD assessments. To determine agreement between individual items, Cohen's kappa coefficients were calculated. Absolute agreement between assessment methods was quantified using a one-way random intra-class correlation coefficient for a single measure.Results: Forty-six patients with IBD participated. The mean FFQ-MDS was 4.59 (standard deviation [SD] = 1.65), and mean RD-MDS was 4.83 (SD = 1.53). Kappa coefficients for individual MEDAS items ranged from 0.41 to 0.78 (p < 0.01) between the FFQ- and RD-MDS. Most items demonstrated moderate to substantial agreement. The intra-class correlation coefficient for absolute agreement between the summed FFQ-MDS and RD-MDS was 0.71 (95% confidence interval: 0.52-0.83, p < 0.001), indicating moderate reliability.Conclusions: This patient-completed FFQ may be a promising tool in clinical practice and research and would benefit from additional evaluation to validate its use in patients with IBD.
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Affiliation(s)
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Zeidler Ledcor Centre, Edmonton, AB
| | - Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, AB
- Department of Community Health Sciences, University of Calgary, Calgary, AB
- Snyder Institute of Chronic Diseases, University of Calgary, Calgary, AB
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Strauss JC, Haskey N, Ramay HR, Ghosh TS, Taylor LM, Yousuf M, Ohland C, McCoy KD, Ingram RJM, Ghosh S, Panaccione R, Raman M. Weighted Gene Co-Expression Network Analysis Identifies a Functional Guild and Metabolite Cluster Mediating the Relationship between Mucosal Inflammation and Adherence to the Mediterranean Diet in Ulcerative Colitis. Int J Mol Sci 2023; 24:ijms24087323. [PMID: 37108484 PMCID: PMC10138710 DOI: 10.3390/ijms24087323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/09/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Diet influences the pathogenesis and clinical course of inflammatory bowel disease (IBD). The Mediterranean diet (MD) is linked to reductions in inflammatory biomarkers and alterations in microbial taxa and metabolites associated with health. We aimed to identify features of the gut microbiome that mediate the relationship between the MD and fecal calprotectin (FCP) in ulcerative colitis (UC). Weighted gene co-expression network analysis (WGCNA) was used to identify modules of co-abundant microbial taxa and metabolites correlated with the MD and FCP. The features considered were gut microbial taxa, serum metabolites, dietary components, short-chain fatty acid and bile acid profiles in participants that experienced an increase (n = 13) or decrease in FCP (n = 16) over eight weeks. WGCNA revealed ten modules containing sixteen key features that acted as key mediators between the MD and FCP. Three taxa (Faecalibacterium prausnitzii, Dorea longicatena, Roseburia inulinivorans) and a cluster of four metabolites (benzyl alcohol, 3-hydroxyphenylacetate, 3-4-hydroxyphenylacetate and phenylacetate) demonstrated a strong mediating effect (ACME: -1.23, p = 0.004). This study identified a novel association between diet, inflammation and the gut microbiome, providing new insights into the underlying mechanisms of how a MD may influence IBD. See clinicaltrials.gov (NCT04474561).
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Affiliation(s)
- Jaclyn C Strauss
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Natasha Haskey
- Department of Biology, Irving K Barber Faculty of Science, University of British Columbia-Okanagan, 3137 University Way, Kelowna, BC V1V 1V7, Canada
| | - Hena R Ramay
- International Microbiome Centre, HRIC 4AA08 Foothills Campus, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Tarini Shankar Ghosh
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, College Road, National University of Ireland, T12 K8AF Cork, Ireland
| | - Lorian M Taylor
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Munazza Yousuf
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Christina Ohland
- International Microbiome Centre, HRIC 4AA08 Foothills Campus, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Kathy D McCoy
- International Microbiome Centre, HRIC 4AA08 Foothills Campus, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Richard J M Ingram
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Subrata Ghosh
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, College Road, National University of Ireland, T12 K8AF Cork, Ireland
| | - Remo Panaccione
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Maitreyi Raman
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
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D’Silva A, Marshall DA, Vallance JK, Nasser Y, Taylor LM, Lazarescu A, Raman M. Gastroenterologist and Patient Attitudes Toward Yoga as a Therapy for Irritable Bowel Syndrome: An Application of the Theory of Planned Behaviour. J Can Assoc Gastroenterol 2022; 6:17-25. [PMID: 36789144 PMCID: PMC9915057 DOI: 10.1093/jcag/gwac028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives To identify irritable bowel syndrome (IBS) patients' attitudes, subjective norms, perceived control and intention to practice yoga and gastroenterologists' attitudes and current yoga recommendations for their patients with IBS. Methods Gastroenterologists and IBS patients completed online surveys including Theory of Planned Behaviour (TPB) constructs. Among IBS patients, multiple linear regression determined the multivariate associations between TPB variables and intention to practice yoga while controlling for significant socio-demographic variables. Gastroenterologists were asked about their attitudes and current yoga recommendations for patients with IBS. Chi-square analyses examined associations between gastroenterologists' demographics and recommending yoga. Binomial logistic regression described associations between attitude variables and current yoga recommendations. Results For patients (n = 109), controllability (β = 0.5, P < 0.001), affective attitude (β = 0.4, P < 0.05) and self-efficacy (β = 0.3, P < 0.05) were significantly associated with intention to do yoga in the regression model. TPB variables explained 34% of the variance in patients' intentions to practice yoga. The binomial regression analysis revealed that gastroenterologists (n = 79) who have confidence in recommending yoga (39%) were seven times more likely to recommend it (odds ratio = 7.3, P = 0.002) and those who agreed yoga improves IBS symptom severity (54%) were 10 times more likely to recommend yoga (odds ratio = 10.1, P < 0.001). Most (86%) wanted more evidence to support efficacy of yoga for IBS and 44% asked for more knowledge on how to refer a patient. Conclusion Controllability, affective attitude and self-efficacy predicted IBS patients' intentions to practice yoga. Although gastroenterologists believed yoga is safe and beneficial for IBS patients, most do not recommend yoga due to lack of confidence and scientific evidence.
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Affiliation(s)
- Adrijana D’Silva
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Arthur J.E. Child Chair, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Yasmin Nasser
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lorian M Taylor
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adriana Lazarescu
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maitreyi Raman
- Correspondence: Maitreyi Raman, MD, Faculty of Medicine, University of Calgary, 6D33 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada, e-mail:
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Raman M, Ma C, Taylor LM, Dieleman LA, Gkoutos GV, Vallance JK, McCoy KD, Lewis I, Jijon H, McKay DM, Mutch DM, Barkema HW, Gibson D, Rauch M, Ghosh S. Crohn's disease therapeutic dietary intervention (CD-TDI): study protocol for a randomised controlled trial. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000841. [PMID: 35046093 PMCID: PMC8772401 DOI: 10.1136/bmjgast-2021-000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/04/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Dietary patterns that might induce remission in patients with active Crohn's disease (CD) are of interest to patients, but studies are limited in the published literature. We aim to explore the efficacy of the CD therapeutic dietary intervention (CD-TDI), a novel dietary approach developed from best practices and current evidence, to induce clinical and biomarker remission in adult patients with active CD. METHODS AND ANALYSIS This study is a 13-week, multicentre, randomised controlled trial in patients with mild-to-moderate active CD at baseline. One hundred and two patients will be block randomised, by sex, 2:1 to the intervention (CD-TDI) or conventional management. Coprimary outcomes are clinical and biomarker remission, defined as a Harvey Bradshaw Index of <5 and a faecal calprotectin of <250 µg/g, respectively.Secondary outcomes include gut microbiota diversity and composition, faecal short-chain fatty acids, regulatory macrophage function, serum and faecal metabolomics, C reactive protein, peripheral blood mononuclear cell gene expression profiles, quality of life, sedentary time and physical activity at 7 and/or 13 weeks. Predictive models of clinical response to a CD-TDI will be investigated. ETHICS AND DISSEMINATION The research protocol was approved by the Conjoint Health Research Ethics Board at the University of Calgary (REB19-0402) and the Health Research Ethics Board-Biomedical Panel at the University of Alberta (Pro00090772). Study findings will be presented at national and international conferences, submitted for publication in abstracts and manuscripts, shared on social media and disseminated through patient-education materials. TRIAL REGISTRATION NUMBER NCT04596566.
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Affiliation(s)
- Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Ma
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lorian M Taylor
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Levinus A Dieleman
- Department of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Georgios V Gkoutos
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Kathy D McCoy
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Ian Lewis
- Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Humberto Jijon
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Derek M McKay
- Department of Physiology and Pharmacology, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
| | - David M Mutch
- Department of Human Health & Nutritional Science, University of Guelph, Guelph, Ontario, Canada
| | - Herman W Barkema
- Department of Production Animal Health, University of Calgary, Calgary, Alberta, Canada
| | - Deanna Gibson
- Department of Biology, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | | | - Subrata Ghosh
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK
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Taylor LM, Eslamparast T, Farhat K, Kroeker K, Halloran B, Shommu N, Kumar A, Fitzgerald Q, Gramlich L, Abraldes JG, Tandon P, Raman M. Using Patient Completed Screening Tools to Predict Risk of Malnutrition in Patients With Inflammatory Bowel Disease. Crohns Colitis 360 2021; 3:otab043. [PMID: 36776646 PMCID: PMC9802362 DOI: 10.1093/crocol/otab043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Indexed: 12/15/2022] Open
Abstract
Background Malnutrition is associated with adverse clinical outcomes in patients with inflammatory bowel disease (IBD), however, malnutrition screening is not routinely performed. This study aimed to identify the prevalence of malnutrition in patients with IBD and compare the accuracy of patient completed screens to a gold-standard malnutrition assessment tool: the dietitian-completed subjective global assessment (SGA). Methods This cross-sectional study was conducted at 2 hospitals and 2 ambulatory care clinics in Alberta, Canada. Patients with IBD completed 4 malnutrition screening tools: abridged patient-generated SGA (abPG-SGA), Malnutrition Universal Screening Tool (MUST), Canadian Nutrition Screening Tool (CNST), and Saskatchewan IBD-nutrition risk (SaskIBD-NR). Risk of malnutrition was calculated for each tool and differences were compared between IBD subtype and body mass index (BMI) categories. Sensitivity and specificity, negative and positive predictive values (NPV and PPV), and area under the receiver operating characteristic curve (AUC) were calculated compared to SGA. Results Patients with Crohn's disease (n = 149) and ulcerative colitis (n = 96) participated in this study. Overall prevalence of malnutrition using SGA was 23% and malnutrition risk for CNST, abPG-SGA, SaskIBD-NR, and MUST was 37%, 36%, 36%, and 27%, respectively. Overall, the abPG-SGA had the highest sensitivity (83%), PPV (53%), and NPV (94%), and largest AUC (0.837) compared to SGA. For patients with a BMI ≥25 kg/m2, sensitivity and PPV of the abPG-SGA decreased to 73% and 41%, respectively, with a AUC of 0.841. Conclusions Malnutrition is prevalent in patients with IBD and using malnutrition risk screening tools such as the abPG-SGA may be useful to identify patients who would benefit from further assessment.
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Affiliation(s)
- Lorian M Taylor
- Department of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - Tannaz Eslamparast
- Department of Medicine, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8, Canada
| | - Kamal Farhat
- Department of Medicine, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8, Canada
| | - Karen Kroeker
- Division of Gastroenterology, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8, Canada
| | - Brendan Halloran
- Division of Gastroenterology, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8, Canada
| | - Nusrat Shommu
- Department of Family Medicine, University of Calgary, Health Sciences Center, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1, Canada
| | - Ankush Kumar
- Department of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - Quinn Fitzgerald
- Department of Family Medicine, University of Calgary, Health Sciences Center, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1, Canada
| | - Leah Gramlich
- Department of Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Juan G Abraldes
- Department of Medicine, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8, Canada
| | - Puneeta Tandon
- Department of Medicine, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8, Canada
| | - Maitreyi Raman
- Division of Gastroenterology and Hepatology, University of Calgary, 6D26, Teaching Research and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada,Address correspondence to: Maitreyi Raman, MD, FRCPC, Room 6D33, 3280 Hospital Drive NW, Calgary, AB T2N 4N1, Canada ()
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Abstract
The aim of this state-of-the-art narrative review is to evaluate the current evidence about the effectiveness of yoga as therapy for IBS and explore its potential mechanisms of action. The current literature suggests yoga is effective and safe and may target multiple mechanisms involved in treatment of IBS. Evidence from randomized controlled trials identified yoga as more effective compared to pharmacological treatment and equally effective as dietary interventions or moderate-intensity walking. Improvements were seen in both physical health (IBS symptom severity, gastric motility, autonomic and somatic symptom scores, and physical functioning) and mental health outcomes (depression, anxiety, gastrointestinal-specific anxiety, and quality of life). Given favorable changes in IBS-related physical and mental health outcomes, preliminary data supports yoga as beneficial in this population. However, the relatively low-quality evidence resulting from heterogeneity of study designs, interventions, and outcome measures limit our ability to make specific recommendations about the use of yoga as therapy for patients with IBS.
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Affiliation(s)
- Adrijana D'Silva
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Glenda MacQueen
- Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Yasmin Nasser
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Lorian M Taylor
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada
| | - Maitreyi Raman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada. .,Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. .,University of Calgary, 6D33 TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
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Shommu NS, Taylor LM, Panaccione R, Tandon P, Raman M. Nutrition Center of Excellence (COE) in Inflammatory Bowel Disease-A Model and Rationale for Development. J Can Assoc Gastroenterol 2019; 2:63-70. [PMID: 31294367 PMCID: PMC6507276 DOI: 10.1093/jcag/gwy028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Goals The goal of this study was to develop a multi-disciplinary consensus of nutrition care priorities for implementation in an IBD nutrition center of excellence (COE). Background The role for nutrition care in inflammatory bowel disease is broad and encompasses multiple domains. Gaps exist in the published literature around best nutrition care practices in inflammatory bowel disease and highlight the need for an evidence based approach acceptable to patients, and generalizable to a wide inflammatory bowel disease population. Study Twelve health leaders in inflammatory bowel disease care attended a 1-day retreat. Two focus groups were completed using traditional focus group methodology for the first half of the retreat and a World Café method for the second half. Data analysis included review of analytic memos and conceptual analysis completed at the time of discussion, theme identification and team consensus for conceptual development. Results Three primary themes were identified as the main pillars of a COE in an IBD nutrition center of excellence. These include: a) excellence in clinical care, b) novel discovery and research, and c) knowledge translation to patients and practitioners. The key initial steps identified in this study included standardizing malnutrition screening and support while creating an environment where nutrition therapy is included as a standard of care, developing and examining the effectiveness of novel diet therapies, and translating knowledge to build capacity among care providers and patients. Conclusions Using a 1-day retreat to identify a future direction for a center focused on nutrition excellence and align our coalition towards common goals was a successful strategy to develop consensus and identify nutrition care priorities for action.
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Affiliation(s)
- Nusrat S Shommu
- Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lorian M Taylor
- Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Remo Panaccione
- Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Puneeta Tandon
- Division of Gastroenterology, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maitreyi Raman
- Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Fielding A, Taylor LM, Moriartey S, Stadynk J. Evaluation of a Patient Experience Tool in Dietetic Practice: Validation and Clinical Usage of the Assessment of Registered Dietitian Care Survey (ARCS). CAN J DIET PRACT RES 2019; 80:48-54. [PMID: 30430857 DOI: 10.3148/cjdpr-2018-036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: The study aim was to evaluate a patient experience survey, the Assessment of Registered Dietitian Care Survey (ARCS), that is aligned with a nutrition counselling approach (NCA) and evidence-based chronic disease care for use in outpatient registered dietitian (RD) practice. Methods: Criterion and construct validity were examined using Pearson correlation coefficients and principal components analyses, respectively. Reliability was examined using Pearson correlations and Cronbach's α. Acceptability was evaluated by survey response rate and readability. Kruskall-Wallis test was used to detect differences between RD scores. Results: A total of 479 survey packages were returned (46% response rate). Criterion validity indices were high (r = 0.91 and 0.94, P < 0.001) between Patient Assessment of Chronic Illness Care (PACIC) and NCA subscales, respectively, and lower with overall patient satisfaction (r = 0.63-0.65, P < 0.001). Construct validity revealed 2 factors for PACIC and NCA subscales. There was high internal reliability for the PACIC, 5As, and NCA (Cronbach's α > 0.7) and test-retest reliability showed an adequate consistency over time (r = 0.70, P < 0.05). The tool was able to detect differences in scores between RDs (P < 0.05). Conclusions: More research is warranted to explore ceiling effects and sensitivity to intervention in similar practice settings. The NCA subscale has acceptable reliability and validity to measure patient experience of RD care.
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Affiliation(s)
- Allison Fielding
- Nutrition Services, Alberta Health Services, Edmonton, AB.,Nutrition Services, Alberta Health Services, Edmonton, AB
| | - Lorian M Taylor
- Nutrition Services, Alberta Health Services, Edmonton, AB.,Nutrition Services, Alberta Health Services, Edmonton, AB
| | - Stephanie Moriartey
- Nutrition Services, Alberta Health Services, Edmonton, AB.,Nutrition Services, Alberta Health Services, Edmonton, AB
| | - Janet Stadynk
- Nutrition Services, Alberta Health Services, Edmonton, AB.,Nutrition Services, Alberta Health Services, Edmonton, AB
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Vallance JK, Gardiner PA, Lynch BM, D'Silva A, Boyle T, Taylor LM, Johnson ST, Buman MP, Owen N. Evaluating the Evidence on Sitting, Smoking, and Health: Is Sitting Really the New Smoking? Am J Public Health 2018; 108:1478-1482. [PMID: 30252516 PMCID: PMC6187798 DOI: 10.2105/ajph.2018.304649] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2018] [Indexed: 01/05/2023]
Abstract
Sitting has frequently been equated with smoking, with some sources even suggesting that smoking is safer than sitting. This commentary highlights how sitting and smoking are not comparable. The most recent meta-analysis of sedentary behavior and health outcomes reported a hazard ratio of 1.22 (95% confidence interval [CI] = 1.09, 1.41) for all-cause mortality. The relative risk (RR) of death from all causes among current smokers, compared with those who have never smoked, is 2.80 (95% CI = 2.72, 2.88) for men and 2.76 for women (95% CI = 2.69, 2.84). The risk is substantially higher for heavy smokers (> 40 cigarettes per day: RR = 4.08 [95% CI = 3.68, 4.52] for men, and 4.41 [95% CI = 3.70, 5.25] for women). These estimates correspond to absolute risk differences of more than 2000 excess deaths from any cause per 100 000 persons per year among the heaviest smokers compared with never smokers, versus 190 excess deaths per 100 000 persons per year when comparing people with the highest volume of sitting with the lowest. Conflicting or distorted information about health risks related to behavioral choices and environmental exposures can lead to confusion and public doubt with respect to health recommendations.
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Affiliation(s)
- Jeff K Vallance
- Jeff K. Vallance and Steven T. Johnson are with the Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada. Paul A. Gardiner is with the Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia. Brigid M. Lynch is with the Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia. Adrijana D'Silva is with the Faculty of Kinesiology, University of Calgary, Calgary, Alberta. Terry Boyle is with Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. Lorian M. Taylor is with the Cumming School of Medicine, University of Calgary. Matthew P. Buman is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ. Neville Owen is with the Behavioural Epidemiology Laboratory, Baker Heart & Diabetes Institute, Melbourne
| | - Paul A Gardiner
- Jeff K. Vallance and Steven T. Johnson are with the Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada. Paul A. Gardiner is with the Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia. Brigid M. Lynch is with the Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia. Adrijana D'Silva is with the Faculty of Kinesiology, University of Calgary, Calgary, Alberta. Terry Boyle is with Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. Lorian M. Taylor is with the Cumming School of Medicine, University of Calgary. Matthew P. Buman is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ. Neville Owen is with the Behavioural Epidemiology Laboratory, Baker Heart & Diabetes Institute, Melbourne
| | - Brigid M Lynch
- Jeff K. Vallance and Steven T. Johnson are with the Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada. Paul A. Gardiner is with the Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia. Brigid M. Lynch is with the Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia. Adrijana D'Silva is with the Faculty of Kinesiology, University of Calgary, Calgary, Alberta. Terry Boyle is with Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. Lorian M. Taylor is with the Cumming School of Medicine, University of Calgary. Matthew P. Buman is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ. Neville Owen is with the Behavioural Epidemiology Laboratory, Baker Heart & Diabetes Institute, Melbourne
| | - Adrijana D'Silva
- Jeff K. Vallance and Steven T. Johnson are with the Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada. Paul A. Gardiner is with the Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia. Brigid M. Lynch is with the Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia. Adrijana D'Silva is with the Faculty of Kinesiology, University of Calgary, Calgary, Alberta. Terry Boyle is with Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. Lorian M. Taylor is with the Cumming School of Medicine, University of Calgary. Matthew P. Buman is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ. Neville Owen is with the Behavioural Epidemiology Laboratory, Baker Heart & Diabetes Institute, Melbourne
| | - Terry Boyle
- Jeff K. Vallance and Steven T. Johnson are with the Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada. Paul A. Gardiner is with the Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia. Brigid M. Lynch is with the Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia. Adrijana D'Silva is with the Faculty of Kinesiology, University of Calgary, Calgary, Alberta. Terry Boyle is with Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. Lorian M. Taylor is with the Cumming School of Medicine, University of Calgary. Matthew P. Buman is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ. Neville Owen is with the Behavioural Epidemiology Laboratory, Baker Heart & Diabetes Institute, Melbourne
| | - Lorian M Taylor
- Jeff K. Vallance and Steven T. Johnson are with the Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada. Paul A. Gardiner is with the Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia. Brigid M. Lynch is with the Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia. Adrijana D'Silva is with the Faculty of Kinesiology, University of Calgary, Calgary, Alberta. Terry Boyle is with Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. Lorian M. Taylor is with the Cumming School of Medicine, University of Calgary. Matthew P. Buman is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ. Neville Owen is with the Behavioural Epidemiology Laboratory, Baker Heart & Diabetes Institute, Melbourne
| | - Steven T Johnson
- Jeff K. Vallance and Steven T. Johnson are with the Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada. Paul A. Gardiner is with the Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia. Brigid M. Lynch is with the Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia. Adrijana D'Silva is with the Faculty of Kinesiology, University of Calgary, Calgary, Alberta. Terry Boyle is with Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. Lorian M. Taylor is with the Cumming School of Medicine, University of Calgary. Matthew P. Buman is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ. Neville Owen is with the Behavioural Epidemiology Laboratory, Baker Heart & Diabetes Institute, Melbourne
| | - Matthew P Buman
- Jeff K. Vallance and Steven T. Johnson are with the Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada. Paul A. Gardiner is with the Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia. Brigid M. Lynch is with the Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia. Adrijana D'Silva is with the Faculty of Kinesiology, University of Calgary, Calgary, Alberta. Terry Boyle is with Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. Lorian M. Taylor is with the Cumming School of Medicine, University of Calgary. Matthew P. Buman is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ. Neville Owen is with the Behavioural Epidemiology Laboratory, Baker Heart & Diabetes Institute, Melbourne
| | - Neville Owen
- Jeff K. Vallance and Steven T. Johnson are with the Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada. Paul A. Gardiner is with the Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia. Brigid M. Lynch is with the Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia. Adrijana D'Silva is with the Faculty of Kinesiology, University of Calgary, Calgary, Alberta. Terry Boyle is with Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. Lorian M. Taylor is with the Cumming School of Medicine, University of Calgary. Matthew P. Buman is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ. Neville Owen is with the Behavioural Epidemiology Laboratory, Baker Heart & Diabetes Institute, Melbourne
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Baydock T, Bector S, Taylor LM, Hansen G. Survey of Nutrition Practice in Patients with Severe Sepsis among Canadian Registered Dietitians. CAN J DIET PRACT RES 2018; 80:8-13. [PMID: 30280922 DOI: 10.3148/cjdpr-2018-029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE The purpose of this study was to determine the opinions and reported nutrition practices of Canadian Registered Dietitians (RDs) with regard to feeding patients with severe sepsis. METHODS In 2017, surveys were sent to 112 eligible Canadian RDs in 10 provinces who were practicing in an intensive care environment. The survey included embedded branching logic questions developed to address major facets of sepsis, critical illness, and nutrition. The survey instrument assimilated all data in an anonymous manner, so respondents could not be linked to their answers. RESULTS Of the 64 RDs who responded (57% response rate), the majority practiced in adult intensive care (81%), within an academic center (59%), and in a mixed unit (73%). A wide variability of Canadian RDs' opinions and practice was reported in determining energy requirements, enteral nutrition (EN) practice, EN with vasoactive agents, parenteral nutrition (PN), and supplemental micronutrients. CONCLUSIONS Practice variability of Canadian RDs likely reflects gaps in both evidence and guidelines for severe sepsis. Further research efforts are needed to customize nutritional requirements in the patient with evolving sepsis, EN with patients at high risk for gastrointestinal dysfunction, optimizing PN, and the role of micronutrients.
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Affiliation(s)
- Trisha Baydock
- a Department of Nutrition and Food Services, Health Sciences Centre, Winnipeg, MB
| | - Savita Bector
- a Department of Nutrition and Food Services, Health Sciences Centre, Winnipeg, MB
| | - Lorian M Taylor
- b Cummings School of Medicine, University of Calgary, Calgary, AB
| | - Gregory Hansen
- c Division of Pediatric Intensive Care, University of Saskatchewan, Saskatoon, SK
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Johnson ST, Eurich DT, Lytvyak E, Mladenovic A, Taylor LM, Johnson JA, Vallance JK. Walking and type 2 diabetes risk using CANRISK scores among older adults. Appl Physiol Nutr Metab 2017; 42:33-38. [DOI: 10.1139/apnm-2016-0267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The objective of this study was to determine the association between pedometer-assessed steps and type 2 diabetes risk using the Public Health Agency of Canada-developed 16-item Canadian Diabetes Risk Questionnaire (CANRISK) among a large population-based sample of older adults across Alberta, Canada. To achieve our study objective, adults without type 2 diabetes (N = 689) aged 55 years and older provided demographic data and CANRISK scores through computer-assisted telephone interviews between September and November 2012. Respondents also wore a step pedometer over 3 consecutive days to estimate average daily steps. Logistic regression was used to assess the association between achieving 7500 steps/day and risk of diabetes (low vs. moderate and high). Overall, 41% were male, average age was 63.4 (SD 5.5) years, body mass index was 26.7 (SD 5.0) kg/m2, and participants averaged 5671 (SD 3529) steps/day. All respondents indicated they were capable of walking for at least 10 min unassisted. CANRISK scores ranged from 13–60, with 18% in the low-risk category (<21). After adjustment, those not achieving 7500 steps/day (n = 507) were more than twice as likely to belong to the higher risk categories for type 2 diabetes compared with those walking ≥7500 steps/day (n = 182) (73.6% vs. 26.4%; odds ratio: 2.37; 95% confidence interval: 1.58 – 3.57). Among older adults without diabetes, daily steps were strongly and inversely associated with diabetes risk using the CANRISK score. Walking remains an important modifiable risk factor target for type 2 diabetes and achieving at least 7500 steps/day may be a reasonable target for older adults.
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Affiliation(s)
- Steven T. Johnson
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB T9S 3A3, Canada
| | - Dean T. Eurich
- School of Public Health, University of Alberta, Edmonton, AB T6G 2H9, Canada
| | - Ellina Lytvyak
- School of Public Health, University of Alberta, Edmonton, AB T6G 2H9, Canada
| | - Ana Mladenovic
- School of Public Health, University of Alberta, Edmonton, AB T6G 2H9, Canada
| | - Lorian M. Taylor
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB T9S 3A3, Canada
| | - Jeffrey A. Johnson
- School of Public Health, University of Alberta, Edmonton, AB T6G 2H9, Canada
| | - Jeff K. Vallance
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB T9S 3A3, Canada
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Affiliation(s)
| | | | | | - L M Taylor
- Department of Surgery, Royal Postgraduate Medical School and Hammersmith Hospital, London W12 0HS
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Taylor LM, Moriartey S, Stadnyk J, Basualdo-Hammond C. Assessment of Registered Dietitians' Beliefs and Practices for a Nutrition Counselling Approach. CAN J DIET PRACT RES 2016; 77:140-7. [PMID: 27182954 DOI: 10.3148/cjdpr-2016-004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE This study describes registered dietitians' (RDs) perceptions and use of a nutrition counselling approach (NCA) as defined by the American Academy of Nutrition and Dietetics Nutrition Care Process terminology (NCPT). METHODS A cross-sectional online survey was administered to approximately 500 RDs in Alberta, Canada. Items included demographics, job characteristics, perceived knowledge, competence, use of an NCA, training experience, and theory of planned behaviour salient beliefs. Descriptive analyses compared RDs who counselled "all or most" of their clients with those who counselled "some or none." Salient beliefs were analyzed using content analysis. RESULTS Of the 349 RDs who completed the survey, 64.2% provided an NCA to "all or most" of their patients. RDs were supportive of using an NCA (mean = 8.7/10, SD = 1.9) and most RDs (84.5%) had received training on an NCA. Salient beliefs included advantages (e.g., improved behaviour change in patients) and disadvantages (e.g., inadequate time). Normative referents included colleagues (e.g., multidisciplinary team), managers, patients/clients, College of RDs of Alberta, and counsellors. The barriers and enablers were related to patients' situations, infrastructure, and RD supports. CONCLUSIONS These results may enable decision makers to more effectively design and target training and implementation programs to improve RDs' NCA.
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Affiliation(s)
| | | | - Janet Stadnyk
- a Alberta Health Services, Nutrition Services, Edmonton, AB
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Vallance JK, Eurich DT, Lynch BM, Gardiner PA, Taylor LM, Jefferis BJ, Johnson ST. Correlates of General and Domain-Specific Sitting Time among Older Adults. Am J Health Behav 2016; 40:362-70. [PMID: 27103415 DOI: 10.5993/ajhb.40.3.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We examined the correlates of sitting time in a population-based sample of older adults. METHODS Adults >55 years of age (N = 1296; N = 515 employed; N = 781 unemployed) self-reported measures of demographic and health-related variables, and a measure of sitting time (ie, SIT-Q). RESULTS Employed total sitting time (min/day) was positively associated with home Internet access (B = 71.2, 95% CI, 8.9 to 133.4, p = .025), body mass index (BMI) (kg/m(2); B = 7.0, 95% CI, 2.1 - 11.9, p = .005), and negatively associated with physical health (B = -2.3; 95% CI, -4.9 to 0.3, p = .013). Unemployed total sitting time was negatively associated with age (B per year = -3.0, 95% CI, -4.9 to -1.1, p = .002), and being male (B = -54.0, 95% CI, -86 .7 to -21.3, p = .001). Unemployed total sitting time was positively associated with Internet access (B = 54.1, 95% CI, 17.7 to 90.4, p = .004) and BMI (B = 4.1, 95% CI, .94 to 7.3, p = .011). CONCLUSIONS Older adults reported low levels of sitting time. Different correlates emerged for the employed and unemployed samples across sitting domains.
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Affiliation(s)
- Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada.
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Brigid M Lynch
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - Paul A Gardiner
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Lorian M Taylor
- Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Barbara J Jefferis
- Department of Primary Care & Population Health, University College London Medical School, London, UK
| | - Steven T Johnson
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
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Taylor LM, Raine KD, Plotnikoff RC, Vallance JK, Sharma AM, Spence JC. Understanding physical activity in individuals with prediabetes: an application of social cognitive theory. PSYCHOL HEALTH MED 2015; 21:254-60. [DOI: 10.1080/13548506.2015.1058486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Johnson ST, Cornish SM, Lytvyak E, Taylor LM, Bell G, Vallance J, Fraser S, Murray T. Examining the Promotion of Healthy Eating among Exercise Specialists: A Cross-sectional Study. CAN J DIET PRACT RES 2015; 76:76-80. [DOI: 10.3148/cjdpr-2015-004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Steven T. Johnson
- Centre for Nursing and Health Studies, Athabasca University, Athabasca, AB
| | - Stephen M. Cornish
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB
| | - Ellina Lytvyak
- Centre for Nursing and Health Studies, Athabasca University, Athabasca, AB
| | | | - Gordon Bell
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB
| | - Jeff Vallance
- Centre for Nursing and Health Studies, Athabasca University, Athabasca, AB
| | - Shawn Fraser
- Centre for Nursing and Health Studies, Athabasca University, Athabasca, AB
| | - Terra Murray
- Centre for Nursing and Health Studies, Athabasca University, Athabasca, AB
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Vallance JK, Eurich DT, Gardiner PA, Taylor LM, Stevens G, Johnson ST. Utility of telephone survey methods in population-based health studies of older adults: an example from the Alberta Older Adult Health Behavior (ALERT) study. BMC Public Health 2014; 14:486. [PMID: 24884997 PMCID: PMC4045920 DOI: 10.1186/1471-2458-14-486] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 05/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Random digit dialing is often used in public health research initiatives to accrue and establish a study sample; however few studies have fully described the utility of this approach. The primary objective of this paper was to describe the implementation and utility of using random digit dialing and Computer Assisted Telephone Interviewing (CATI) for sampling, recruitment and data collection in a large population-based study of older adults [Alberta Older Adult Health Behavior (ALERT) study]. METHODS Using random digit dialing, older adults (> = 55 years) completed health behavior and outcome and demographic measures via CATI. After completing the CATI, participants were invited to receive a step pedometer and waist circumference tape measure via mail to gather objectively derived ambulatory activity and waist circumference assessments. RESULTS Overall, 36,000 telephone numbers were called of which 7,013 were deemed eligible for the study. Of those, 4,913 (70.1%) refused to participate in the study and 804 (11.4%) participants were not included due to a variety of call dispositions (e.g., difficult to reach, full quota for region). A total of 1,296 participants completed telephone interviews (18.5% of those eligible and 3.6% of all individuals approached). Overall, 22.8% of households did not have an age 55+ resident and 13.6% of individuals refused to participate, Average age was 66.5 years, and 43% were male. A total of 1,081 participants (83.4%) also submitted self-measured ambulatory activity (i.e., via step pedometer) and anthropometric data (i.e., waist circumference). With the exception of income (18.7%), the rate of missing data for demographics, health behaviors, and health measures was minimal (<1%). CONCLUSIONS Older adults are willing to participate in telephone-based health surveys when randomly contacted. Researchers can use this information to evaluate the feasibility and the logistics of planned studies using a similar population and study design.
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Affiliation(s)
- Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada.
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Abstract
PURPOSE The primary objective of this study was to determine the physical activity (PA) preferences in a sample of individuals with prediabetes. METHODS Individuals with prediabetes (N = 232) residing in Northern Alberta, Canada completed a mailed questionnaire that assessed demographic and health variables, self-reported PA (Godin Leisure-Time Exercise Questionnaire), and PA preferences. RESULTS Respondents indicated they would like to be counseled about PA (75%), were physically able to participate (96%), were interested in a PA program for individuals with prediabetes (86%), and were most interested in walking (71%). Activity status, number of comorbidities, level of employment, marital status, body mass index, and time since diagnosis with prediabetes all demonstrated significant influence on different PA preference variables. CONCLUSIONS There is a demand for PA-related programs for individuals with prediabetes. Incorporating identified PA preferences of those with prediabetes might aid in the development of relevant intervention tools, programs, and strategies to support PA.
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Affiliation(s)
- Lorian M Taylor
- Faculty of Physical Education and Recreation, University of Alberta, Alberta, Canada.
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Taylor LM, Spence JC, Raine K, Plotnikoff RC, Vallance JK, Sharma AM. Physical activity and health-related quality of life in individuals with prediabetes. Diabetes Res Clin Pract 2010; 90:15-21. [PMID: 20727611 DOI: 10.1016/j.diabres.2010.04.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 04/09/2010] [Accepted: 04/13/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to determine if differences existed in health-related quality of life (HRQoL) between individuals with prediabetes who are physically active (i.e., achieving >or=600METmin per week) compared to those who are inactive. METHOD Individuals with prediabetes (N=232) residing in Northern Alberta, Canada completed a mailed questionnaire assessing self-reported PA, and health-related quality of life in August-September 2008. RESULTS Thirty-eight percent of individuals with prediabetes were meeting prediabetes PA guidelines. Covarying on age, gender, income, smoking and BMI, a significant multivariate analysis of covariance model [Wilks'lambda=0.967, F(2,224)=3.791, p<.05] indicated those achieving PA guidelines reported higher Physical Health (Mean diff=2.7, p<.05, ES=.27) and Mental Health (Mean diff=3.0, p<.05, ES=.31) compared to those not achieving PA guidelines. CONCLUSION These findings demonstrate people with prediabetes who achieve prediabetes PA guidelines have higher levels of physical and mental HRQoL than people who are inactive. Further, these results support the rationale for developing strategically designed PA programs for individuals with prediabetes.
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Affiliation(s)
- Lorian M Taylor
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada.
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Jacobsen DW, Gatautis VJ, Green R, Robinson K, Savon SR, Secic M, Ji J, Otto JM, Taylor LM. Total plasma homocysteine: the mediator/marker controversy continues. 1994. Clin Chem 2009; 55:1742-3. [PMID: 19556442 DOI: 10.1373/clinchem.2009.128744] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Donald W Jacobsen
- Cell Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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Vallance JK, Taylor LM, Lavallee C. Suitability and readability assessment of educational print resources related to physical activity: implications and recommendations for practice. Patient Educ Couns 2008; 72:342-9. [PMID: 18450409 DOI: 10.1016/j.pec.2008.03.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 02/05/2008] [Accepted: 03/09/2008] [Indexed: 05/20/2023]
Abstract
OBJECTIVE The primary objective of this study was to assess the suitability and readability level of publicly available educational print resources related to physical activity (PA). METHODS Educational print resources related to PA (n=66) were requested from organizations (e.g., professional, commercial, government, and educational). The suitability assessment of materials (SAM) and the simple measure of gobbledygook (SMOG) readability measure were used to evaluate the suitability and readability of the PA resources. RESULTS Of the 66 PA resources, suitability scores were superior in only 10 resources (15%), adequate in 36 resources (55%), and inadequate/not suitable in 20 resources (30%). The average reading grade level for the PA resources was a 10th grade level (S.D.=1.82; Rg=5th grade to 15th grade). Only 56.5% (n=35) of PA resources depicted a primary PA recommendation that was consistent with the public health recommendation for PA. CONCLUSION Results indicate that the majority of educational print resources related to PA have poor readability indices and inadequate to adequate suitability. PRACTICE IMPLICATIONS Health educators developing educational print resources related to PA must ensure these resources conform to the highest suitability standards. This includes developing resources that a) contain information consistent with current public health recommendations, and b) can be utilized by all individuals regardless of health literacy status.
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Affiliation(s)
- Jeff K Vallance
- Centre for Nursing and Health Studies, Athabasca University, Athabasca, AB, Canada.
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Vallance JK, Courneya KS, Taylor LM, Plotnikoff RC, Mackey JR. Development and Evaluation of a Theory-Based Physical Activity Guidebook for Breast Cancer Survivors. Health Educ Behav 2006; 35:174-89. [PMID: 16861593 DOI: 10.1177/1090198106287693] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study's objective was to develop and evaluate the suitability and appropriateness of a theory-based physical activity (PA) guidebook for breast cancer survivors. Guidebook content was constructed based on the theory of planned behavior (TPB) using salient exercise beliefs identified by breast cancer survivors in previous research. Expert judges completed the Maine Area Health Education Center's 18-item attribute checklist for evaluating written health information. Judges indicated that the PA guidebook achieved desirable attributes for the suitability and appropriateness of the guidebook. A subset of TPB expert judges completed items designed to determine the degree of match between the guidebook content and the respective TPB components. Mean item-content relevance ratings indicated at least a “very good match” between the PA guidebook content and the keyed TPB domains. Theoretically based PA information may be an effective strategy for increasing PA in breast cancer survivors at the population level.
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Affiliation(s)
- Jeffrey K Vallance
- Faculty of Physical Education & Recreation, University of Alberta, Edmonton, Canada
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Plotnikoff RC, Taylor LM, Wilson PM, Courneya KS, Sigal RJ, Birkett N, Raine K, Svenson LW. Factors Associated with Physical Activity in Canadian Adults with Diabetes. Med Sci Sports Exerc 2006; 38:1526-34. [PMID: 16888470 DOI: 10.1249/01.mss.0000228937.86539.95] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The purpose of this study was to identify key demographic and health factors associated with physical activity (PA) participation in adults with type 1 or type 2 diabetes. METHODS Participants were adults > or = 18 yr of age living in the province of Alberta, Canada who were previously diagnosed with type 1 (N = 697) or type 2 (N = 1614) diabetes. Individuals were recruited from the Canadian Diabetes Association (Alberta) registry and through a random digit-dialing protocol. Multiple and logistic regression models were employed to identify demographic and health factors related to PA levels, of which many to date have not been examined in this population. Analyses were conducted separately for type 1 and type 2 groups. RESULTS Of those with type 1 and type 2 diabetes, 63.7 and 71.9%, respectively, were not achieving recommended PA levels. For those with type 1, higher PA levels were associated with a younger age, being single, higher income, lower level of perceived disability, and not smoking. For the type 2 group, a younger age, male gender, higher education, higher income, lower body mass index, and lower level of perceived disability were associated with higher PA levels. CONCLUSIONS Many of our results for both diabetes types are consistent with findings from other limited research in this domain. Contrary to previous research, however, a significant negative relationship was reported between body mass index and PA for the type 2 group. In addition, perceived disability was negatively associated with PA, which, to date, has not been reported in the literature with type 2 individuals. Research and practice related to physical activity promotion for this population should take into account specific demographic and health factors associated with PA.
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Affiliation(s)
- Ronald C Plotnikoff
- Centre for Health Promotion Studies School of Public Health/Faculty of Physical Education, University of Alberta, Edmonton, Alberta, Canada.
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Cerin E, Taylor LM, Leslie E, Owen N. Small-scale randomized controlled trials need more powerful methods of mediational analysis than the Baron-Kenny method. J Clin Epidemiol 2006; 59:457-64. [PMID: 16632133 DOI: 10.1016/j.jclinepi.2005.11.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Revised: 10/07/2005] [Accepted: 11/07/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To devise more-effective physical activity interventions, the mediating mechanisms yielding behavioral change need to be identified. The Baron-Kenny method is most commonly used, but has low statistical power and may not identify mechanisms of behavioral change in small-to-medium size studies. More powerful statistical tests are available. STUDY DESIGN AND SETTING Inactive adults (N=52) were randomized to either a print or a print-plus-telephone intervention. Walking and exercise-related social support were assessed at baseline, after the intervention, and 4 weeks later. The Baron-Kenny and three alternative methods of mediational analysis (Freedman-Schatzkin; MacKinnon et al.; bootstrap method) were used to examine the effects of social support on initial behavior change and maintenance. RESULTS A significant mediational effect of social support on initial behavior change was indicated by the MacKinnon et al., bootstrap, and, marginally, Freedman-Schatzkin methods, but not by the Baron-Kenny method. No significant mediational effect of social support on maintenance of walking was found. CONCLUSIONS Methodologically rigorous intervention studies to identify mediators of change in physical activity are costly and labor intensive, and may not be feasible with large samples. The use of statistically powerful tests of mediational effects in small-scale studies can inform the development of more effective interventions.
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Affiliation(s)
- Ester Cerin
- Cancer Prevention Research Centre, School of Population Health, The University of Queensland, Herston Road, Herston, Brisbane, QLD 4006, Australia.
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van Dijkhuizen-Radersma R, Wright SJ, Taylor LM, John BA, de Groot K, Bezemer JM. In Vitro/in Vivo Correlation for14C-Methylated Lysozyme Release from Poly(Ether-Ester) Microspheres. Pharm Res 2004; 21:484-91. [PMID: 15070100 DOI: 10.1023/b:pham.0000019303.12086.d1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE The purpose of this study was to obtain an in vitro/in vivo correlation for the sustained release of a protein from poly(ethylene glycol) terephthalate (PEGT)/poly(butylene terephthalate) (PBT) microspheres. METHODS Radiolabeled lysozyme was encapsulated in PEGT/PBT microspheres via a water-in-oil-in-water emulsion. Three microsphere formulations varying in copolymer composition were administered subcutaneously to rats. The blood plasma was analyzed for radioactivity content representing released lysozyme at various time points post-dose. The in vitro release was studied in phosphate-buffered saline. RESULTS The encapsulation efficiency, calculated from the radioactivity in the outer water phase of the emulsion, varied from 60-87%. Depending on the PEG segment length and wt% PEGT, the lysozyme was released completely in vitro within 14 to 28 days without initial burst. 14C-methylated lysozyme could be detected in the plasma over the same time courses. The in vitro/in vivo correlation coefficients obtained from point-to-point analysis were greater than 0.96 for all microsphere formulations. In addition, less then 10% of administered radioactivity remained at dose site at 28 days for the microsphere formulations, indicating no notable retention of the protein at the injection site. CONCLUSION The in vitro release in phosphate-buffered saline and the in vivo release in rats showed an excellent congruence independent of the release rate of 14C-methylated lysozyme from PEGT/PBT microspheres.
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Abstract
A new UV filter compound, 4-(2-amino-3-hydroxyphenyl)-4-oxobutanoic acid O-diglucoside, has been identified in human lenses. The structure suggests that it is a further metabolic product of the second most abundant UV filter compound, 4-(2-amino-3-hydroxyphenyl)-4-oxobutanoic acid O-glucoside. Quantification studies on the new compound show that it decreases towards zero in both the nucleus and cortex as a function of age. The discovery of this novel disaccharide completes the identification of the major UV filter compounds present in the human lens.
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Affiliation(s)
- L M Taylor
- Australian Cataract Research Foundation, University of Wollongong, NSW 2522, Australia
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Lam EY, Taylor LM, Landry GJ, Porter JM, Moneta GL. Relationship between antiphospholipid antibodies and progression of lower extremity arterial occlusive disease after lower extremity bypass operations. J Vasc Surg 2001; 33:976-82. [PMID: 11331837 DOI: 10.1067/mva.2001.115163] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Antiphospholipid antibodies (APLs), which consist of anticardiolipin antibodies (ACLs) or lupus anticoagulant (LA), are associated with venous thrombosis, stroke, and cardiac events. Although they are present in many patients with lower extremity atherosclerotic occlusive disease (LEAOD), the relationship between APL and the progression of LEAOD has not been reported. A comparison of progression of LEAOD as determined with direct imaging studies in patients with and without APL forms the basis for this report. METHODS APL+ patients (immunoglobulin M [IgM] or IgA or IgG ACL > 3 SD units above control mean or positive LA) who underwent lower extremity bypass grafting between January 1990 and June 1999 (n = 79) were compared with an APL control group (n = 68). Members of the study and control groups were similar with respect to age, procedure, sex, length of follow-up, and multiple atherosclerosis risk factors. Progression of LEAOD was determined by comparing preoperative arteriograms with postoperative imaging studies (arteriograms or duplex scanning). External iliac, common femoral, superficial femoral and popliteal arteries were graded as < 50% stenosis, > or = 50% stenosis, or occluded. Posterior tibial and anterior tibial arteries were graded as patent or occluded. Progression was defined as any increase in stenosis category. RESULTS The mean follow-up period was 31 months for APL+ and 35 months for APL- patients (P = not significant). Progression of LEAOD occurred in 58 (73%) of 79 APL+ patients and in 25 (37%) of 68 APL- patients (P <.001). There was no difference in progression in external iliac or common femoral arteries. Differences in progression were noted in more distal arteries; APL+ patients had significantly more progression in superficial femoral (45% vs 16%, P <.01), popliteal (31% vs 12%, P <.01), posterior tibial (29% vs 13%, P <.05), and anterior tibial arteries (29% vs 14%, P <.05). Multivariate logistic regression analysis showed a significant independent association between the presence of APL and progression of LEAOD (P <.0001). CONCLUSION In this study, the presence of APL in patients undergoing lower extremity bypass operations was a significant independent risk factor for progression of LEAOD. We conclude that this patient group should be closely monitored in the postoperative period and appears ideally suited for prospective studies of therapies to modify LEAOD progression.
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Affiliation(s)
- E Y Lam
- Oregon Health Sciences University, Portland, USA
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Abstract
INTRODUCTION Detailed information on functional outcome after open abdominal aortic aneurysm (AAA) repair is sparse. Information about functional outcome of open AAA repair is essential to allow comparison of treatment modalities. METHODS To determine the functional outcome of patients after open repair of AAA, we reviewed 154 consecutive, nonemergency open repairs of infrarenal AAAs between 1990 and 1997 and each patient's medical records. Clinical variables were recorded for each patient, as were multiple outcomes, including ambulatory status, independent living status, current medical condition, and the patient's perception of recovery and satisfaction. Eighty-seven patients or their families were available for current telephone interview to obtain information about objective functional activities, including walking and driving, and subjective functional information, including assessment of complete recovery and willingness to undergo AAA repair again. Chart data were available for all 154 patients. RESULTS There were 42 women and 112 men. A total of 139 operations were elective, and 15 were urgent. The operative mortality rate was 4%, mean hospital stay was 10.7 +/- 1.3 days, and mean intensive care unit stay was 4.57 +/- 1.17 days. Seventeen (11%) patients required transfer to a skilled nursing facility with a mean stay of 3.66 +/- 2.9 months. All patients were ambulatory preoperatively, whereas at last follow-up (median, 25 months; range, 0.13-108.5 months), 100 (64%) of the patients remained ambulatory, 34 (22%) required assistance, and 12 (14%) were nonambulatory. At current assessment by telephone interview, 33% of patients described a decrease in their functional activity including driving, shopping, and traveling compared with their preoperative status, whereas 67% were unchanged. When asked to assess their own degree of recovery, 64% of patients stated that they experienced complete recovery with an average time to recovery of 3.9 months, whereas 33% said they had not fully recovered at a mean follow-up of 34 months. Sixteen (18%) patients said they would not undergo AAA repair again knowing the recovery process, even though they appeared to fully understand the implication of AAA rupture. CONCLUSION Patients undergoing open AAA repair generally experienced significant freedom from surgical complications. However, substantial functional impairment was present. It is unclear whether the functional disability resulted from the AAA surgery or from aging and comorbidities unrelated to surgery.
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Affiliation(s)
- W K Williamson
- Division of Vascular Surgery, Oregon Health Sciences University, Portland, OR, USA
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Landry GJ, Moneta GL, Taylor LM, Edwards JM, Porter JM. Long-term functional outcome of neurogenic thoracic outlet syndrome in surgically and conservatively treated patients. J Vasc Surg 2001; 33:312-7; discussion 317-9. [PMID: 11174783 DOI: 10.1067/mva.2001.112950] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Neurogenic thoracic outlet syndrome (NTOS) in the absence of bony and electrodiagnostic abnormalities, often referred to as disputed NTOS, remains enigmatic. Optimal treatment, especially the role of surgery, is controversial. The long-term functional outcome of a cohort of patients undergoing independent medical examination for disputed NTOS with symptoms sufficiently severe to cause inability to work forms the basis for this report. METHODS Patients with disputed NTOS and symptoms sufficiently severe to cause at least temporary inability to work seen for independent medical examinations from 1990-1998 formed the study group. None of the patients were treated by our group. Functional outcome was assessed with information from a standardized telephone interview or patient questionnaire. The patients' ability to return to work and an assessment of their current level of symptoms and symptom progression since the time of onset were determined. RESULTS Seventy-nine patients were reevaluated at a mean follow-up of 4.2 years (range, 2-7.5 years) after our initial evaluation. Fifteen patients (19%) underwent first rib resection surgery performed by others, whereas 64 (81%) had no surgery. Patients undergoing surgery had missed more work time than those undergoing conservative management (27.6 +/- 6.0 months vs 14.9 +/- 2.6 months, P <.04). Return to work was achieved in nine patients who were operated on (60%) and in 50 patients who were not operated on (78%) (P = not significant [NS]). Among operated patients, current assessment of symptom severity was severe, moderate, mild, and asymptomatic in 7%, 47%, 40% and 7%, respectively. This distribution did not differ significantly from that observed in nonoperated patients (11%, 55%, 30%, 5%; P = NS). When asked about changes in symptomatic status since onset, 7% of the operated group had complete resolution, 27% had marked improvement, 40% had minimal improvement, 13% had no improvement, and 13% were worse. This did not differ significantly from the change in symptoms reported by the nonoperated group (2%, 30%, 22%, 31%, 16%; P = NS). CONCLUSION Most patients with disputed NTOS in this nonrandomized series were able to return to work and demonstrated an improvement of symptoms with long-term follow-up. First rib resection did not improve functional outcome in this group.
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Affiliation(s)
- G J Landry
- Division of Vascular Surgery, Department of Surgery, Oregon Health Sciences University, Portland, OR 97201-3098, USA.
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Lovelace TD, Moneta GL, Abou-Zamzam AM, Edwards JM, Yeager RA, Landry GJ, Taylor LM, Porter JM. Optimizing duplex follow-up in patients with an asymptomatic internal carotid artery stenosis of less than 60%. J Vasc Surg 2001; 33:56-61. [PMID: 11137924 DOI: 10.1067/mva.2001.112303] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The Asymptomatic Carotid Atherosclerosis Study established benefit of carotid endarterectomy for 60% to 99% asymptomatic internal carotid artery (ICA) stenosis. Optimal follow-up intervals to detect progression from < 60% to 60%-99% ICA stenosis are unknown. In a previous study from our laboratory, we found that ICAs with < 60% stenosis and peak systolic velocities (PSVs) of 175 cm/s or more on initial duplex were at high risk for progression. Prospective evaluation of this hypothesis and determination of optimal duplex follow-up intervals for asymptomatic patients with < 60% ICA stenosis form the basis of this report. METHODS All patients who underwent initial carotid duplex examination for any indication since January 1, 1995, with at least one patent, asymptomatic, previously nonoperated ICA with < 60% stenosis; with 6 months' or greater follow-up; and with one or more repeat duplex examinations were entered into the study. On the basis of the initial duplex examination, ICAs were classified into two groups: those with a PSV less than 175 cm/s and those with a PSV of 175 cm/s or more. Follow-up duplex examinations were performed at varying intervals to detect progression from < 60% to 60%-99% ICA stenosis with criteria previously reported (both PSV > or = 260 cm/s and end-diastolic velocity > or = 70 cm/s). RESULTS A total of 407 patients (640 asymptomatic ICAs with < 60% stenosis) underwent serial duplex scans (mean follow-up, 22 months). Three ICAs (0.5%) became symptomatic and progressed to 60%-99% ICA stenosis at a mean of 21 months (all transient ischemic attacks), whereas four other ICAs occluded without stroke during follow-up. Progression to 60%-99% stenosis without symptoms was detected in 46 ICAs (7%) (mean, 18 months). Of the 633 patent asymptomatic arteries, 548 ICAs (87%) had initial PSVs less than 175 cm/s, and 85 ICAs (13%) had initial PSVs of 175 cm/s or more. Asymptomatic progression to 60%-99% ICA stenosis occurred in 22 (26%) of 85 ICAs with initial PSVs of 175 cm/s or more, whereas 24 (4%) of 548 ICAs with initial PSVs less than 175 cm/s progressed (P <.0001). The Kaplan-Meier method was used to determine freedom from progression at 6 months, 12 months, and 24 months, which was 95%, 83%, and 70% for ICAs with initial PSVs of 175 cm/s or more versus 100%, 99%, and 95%, respectively, for ICAs with initial PSVs less than 175 cm/s (P <.0001). CONCLUSIONS Patients with < 60% ICA stenosis and PSVs of 175 cm/s or more on initial duplex examination are significantly more likely to progress asymptomatically to 60%-99% ICA stenosis, and progression is sufficiently frequent to warrant follow-up duplex studies at 6-month intervals. Patients with < 60% ICA stenosis and initial PSVs less than 175 cm/s may have follow-up duplex examinations safely deferred for 2 years.
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Affiliation(s)
- T D Lovelace
- Division of Vascular Surgery, Department of Surgery, Oregon Health Sciences University, Portland VA Medical Center, 97201, USA
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Landry GJ, Moneta GL, Taylor LM, Edwards JM, Yeager RA, Porter JM. Patency and characteristics of lower extremity vein grafts requiring multiple revisions. J Vasc Surg 2000; 32:23-31. [PMID: 10876203 DOI: 10.1067/mva.2000.107306] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Multiple (> 1) revisions of lower extremity vein grafts may be required to maintain patency. Characteristics of recurrent lower extremity vein graft lesions and the patency achieved after multiple revisions have not been emphasized in reports on infrainguinal vein graft stenosis. This study was performed to determine (1) the patency of multiply revised lower extremity vein grafts and (2) the timing, location, and angiographic and duplex features of the recurrent lesions. METHODS Lower extremity vein grafts that were followed in a duplex surveillance protocol and required revisions from January 1990 through December 1998 were identified. All revisions were preceded by angiography. In multiply revised lower extremity vein grafts, the immediate preoperative angiogram and duplex examination findings, as well as the angiogram made before the previous revision and the duplex study done after the previous revision, were reviewed to characterize recurrent lesions at the time of previous and current graft revision. The patencies of grafts undergoing single and multiple revisions were compared. RESULTS A total of 233 lower extremity vein graft revisions were performed; of these, 50 (21%) were repeat revisions. Of grafts requiring more than one revision, 98% were normal on duplex examination after the initial revision. Five-year assisted primary patency of multiply revised grafts (91%) was not different from that of grafts with a single revision (89%; P not significant). Of 60 lesions repaired in the 50 repeat revisions, 29 (48%) were at the previously revised site, and 31 (52%) were at new sites. The time between revisions was less if the same site was revised (11 +/- 2 months) than if a different site required revision (20 +/- 4 months; P <.05). Arteriographic evidence of a minor (< 50% diameter) lesion was present at the time of the initial revision in 23% of cases in which revision of a second site was subsequently required. CONCLUSION In our experience, 21% of lower extremity vein grafts requiring initial revision ultimately require additional revisions. Multiply revised lower extremity vein grafts have excellent long-term patency. Lesions occur with equal frequency at the site of prior revision and new sites. Lesions prompting revision at new sites occur significantly later and are infrequently detected on prior imaging studies.
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Affiliation(s)
- G J Landry
- Division of Vascular Surgery, Department of Surgery, Oregon Health Sciences, University, Portland, OR 97201-3098, USA.
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Foley MI, Moneta GL, Abou-Zamzam AM, Edwards JM, Taylor LM, Yeager RA, Porter JM. Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia. J Vasc Surg 2000; 32:37-47. [PMID: 10876205 DOI: 10.1067/mva.2000.107314] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Complete revascularization is recommended by many authors for treatment of intestinal ischemia. The observation that postprandial intestinal hyperemia is limited to the superior mesenteric artery (SMA) has suggested to us that SMA revascularization alone should be adequate treatment. We preferentially manage intestinal ischemia with a single bypass graft to the SMA and herein update our results using this approach. METHODS Patients were identified from a prospectively established vascular surgical registry. Each patient was assessed for acute versus chronic intestinal ischemia, preoperative angiographic findings, operation used, perioperative morbidity and mortality, late symptomatic relief, cause of death, and life table-determined survival and graft patency. Graft patency was determined by follow-up angiography or duplex scanning. RESULTS Fifty bypass grafts to the SMA alone were performed in 49 patients (31 women, 18 men; mean age, 62 years) for treatment of intestinal ischemia. In all patients additional splanchnic arteries were available for bypass grafting. Operative indications were acute symptoms in 21 patients, 14 of whom had bowel infarction; chronic symptoms in 26 patients; and prophylaxis in conjunction with infrarenal aortic surgery in 3 patients. Thirty-two grafts originated from the aorta or an iliac artery, and 18 originated from an aortic graft. There were 40 prosthetic and 10 autogenous conduits. Perioperative mortality was 3% in patients with chronic symptoms and 12% overall. All survivors were symptomatically improved. Mean follow-up was 44 months. Nine-year assisted primary graft patency was 79%, and 5-year patient survival was 61%. Two late deaths occurred in patients with recurrent intestinal ischemia resulting from graft occlusions. CONCLUSIONS Bypass grafting to the SMA alone appears to be both an effective and durable procedure for treatment of intestinal ischemia. Our results appear equal to those reported for "complete" revascularization for intestinal ischemia. When the SMA is a suitable recipient vessel, multiple bypass grafts to other splanchnic vessels are unnecessary in the treatment of intestinal ischemia.
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Affiliation(s)
- M I Foley
- Division of Vascular Surgery, Oregon Health Sciences University, Portland, OR 97201-3098, USA
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Taylor LM, Khachigian LM. Induction of platelet-derived growth factor B-chain expression by transforming growth factor-beta involves transactivation by Smads. J Biol Chem 2000; 275:16709-16. [PMID: 10828062 DOI: 10.1074/jbc.275.22.16709] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Transforming growth factor-beta (TGF-beta) regulates a diverse array of biological processes, such as proliferation, differentiation, extracellular matrix production, and apoptosis. In cultured vascular endothelial cells, TGF-beta induces the expression of platelet-derived growth factor (PDGF) B-chain, a mitogen and chemoattractant, at the level of transcription. The molecular mechanism(s) underlying this process are not presently understood. In this study, we performed serial 5' deletion and transient transfection analysis to define a region in the PDGF-B promoter mediating inducible responsiveness to TGF-beta. This region contains an atypical nucleotide recognition element for the Smad family of transcriptional regulators. Electrophoretic mobility shift analysis revealed that nuclear proteins bound to this site in a transient and specific manner. Supershift studies demonstrated the physical association of Smad4 with the promoter. Overexpression of Smad4 activated the PDGF-B promoter and superinduced PDGF-B promoter-dependent expression in cells exposed to TGF-beta. Moreover, simultaneous cotransfection of Smad3 and Smad4 activated the PDGF-B promoter. This effect was attenuated when Smad4 was substituted with its dominant negative counterpart. Mutation of the (-81)CAGA(-78) motif in the PDGF-B promoter abrogated Smad-inducible promoter-dependent expression. Overexpression of Smad2 and Smad3 transactivated the PDGF-B promoter in a synergistic manner. These findings demonstrate the existence of a novel, functional binding element in the proximal region of the PDGF-B promoter mediating responsiveness to TGF-beta.
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Affiliation(s)
- L M Taylor
- Centre for Thrombosis and Vascular Research, The University of New South Wales and Prince of Wales Hospital, Sydney, New South Wales 2052, Australia
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Affiliation(s)
- G J Landry
- Division of Vascular Surgery, Oregon Health Sciences University, Portland, OR 97201-3098, USA
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Cipolla MJ, Williamson WK, Nehler ML, Taylor LM, Porter JM. The effect of elevated homocysteine levels on adrenergic vasoconstriction of human resistance arteries: the role of the endothelium and reactive oxygen species. J Vasc Surg 2000; 31:751-9. [PMID: 10753283 DOI: 10.1067/mva.2000.103797] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE This study investigated the effect of elevated homocysteine levels on adrenergic contraction of human resistance arteries and tested the hypothesis that homocysteine-induced generation of reactive oxygen species contributes to vascular reactivity changes. METHODS Small (<200 microm) subcutaneous arteries were cannulated and pressurized in an arteriograph chamber that allowed the measurement of lumen diameter. Two arteries from the same patient were obtained; one was perfused and superfused (intraluminal pressure = 50 mm Hg) with physiologic saline solution (control, n = 6), and the other was perfused and superfused with physiologic saline solution plus 200 micromol/L homocysteine (HC, n = 6); the reactivity to adrenergic stimulation was assessed. Another group of arteries was incubated in 200 micromol/L homocysteine plus 1200 U/mL superoxide dismutase and 120 U/mL catalase (HC + SC, n = 6), and the reactivity to norepinephrine was determined. The vasoreactivity of homocysteine was further assessed in intact (n = 6) and denuded (n = 6) arteries that were precontracted with an intermediate concentration of norepinephrine and homocysteine (20-200 micromol/L) added to the bath while the lumen diameter was continuously recorded. RESULTS Sensitivity to norepinephrine was diminished in HC arteries, which increased the median effective concentration (EC(50)) from 0.24 +/- 0.06 micromol/L in control arteries to 0.65 +/- 0.10 micromol/L in HC arteries (P <.01). Homocysteine also caused concentration-dependent vasodilation of arteries contracted with an intermediate concentration of norepinephrine that was greater in intact than denuded arteries, with the half-maximum responses occurring at 61 +/- 6 micromol/L (intact) and 90 +/- 11 micromol/L (denuded; P <.05). There was no significant difference in sodium nitroprusside sensitivity between control and homocysteine arteries (EC(50) = 61 +/- 3 nmol/L vs 50 +/- 19 nmol/L; P >.05) or in sensitivity to acetylcholine (EC(50) = 19 +/- 7 nmol/L vs 12 +/- 3 nmol/L; P >.05). Arteries in the presence of superoxide dismutase and catalase had similarly impaired reactivity to norepinephrine as did homocysteine arteries (EC(50), 0.58 +/- 0.15 micromol/L; P >.05 vs HC, P <.01 vs control). CONCLUSION An elevated homocysteine level in vitro diminishes adrenergic contraction, with a differential endothelial versus smooth muscle influence that appears unrelated to the generation of reactive oxygen species.
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Affiliation(s)
- M J Cipolla
- Departments of Obstetrics/Gynecology, Pharmacology, and Neurology University of Vermont College of Medicine, Burlington, VT 05405, USA
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Yeager RA, Taylor LM. Axillary artery anastomosis to avoid axillofemoral bypass disruption. Semin Vasc Surg 2000; 13:74-6. [PMID: 10743896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Acute disruption at or adjacent to axillary anastomoses of axillofemoral grafts has been sporadically reported. The cause of this serious complication is believed to be attributable to mechanical stresses on the proximal portion of the graft and anastomosis. A modification in the proximal tunneling of the axillofemoral graft, which appears to have effectively reduced the occurrence of this vexing complication, is described in this report.
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Affiliation(s)
- R A Yeager
- Department of Surgery, Oregon Health Sciences University, and Portland Veteran's Affairs Medical Center, 97207, USA
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Abou-Zamzam AM, Moneta GL, Edwards JM, Yeager RA, Taylor LM, Porter JM. Is a single preoperative duplex scan sufficient for planning bilateral carotid endarterectomy? J Vasc Surg 2000; 31:282-8. [PMID: 10664497 DOI: 10.1016/s0741-5214(00)90159-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Duplex scanning is often the sole imaging study before carotid endarterectomy (CEA). Patients with bilateral severe internal carotid artery (ICA) stenosis may be considered for bilateral CEA. High-grade ICA stenosis, however, may artifactually elevate velocity measurements used to quantify stenosis in the contralateral ICA. It is unknown whether ipsilateral CEA will influence duplex determination of the presence of a contralateral 60% to 99% ICA stenosis. This study was performed to determine whether a single preoperative duplex scan is sufficient to plan bilateral CEA. METHODS Preoperative and early postoperative carotid duplex scans in patients with bilateral ICA stenosis who underwent unilateral CEA were reviewed. Changes in duplex scans that determined stenosis in the ICA contralateral to the CEA were analyzed. Previously validated criteria used to determine 60% to 99% ICA stenosis were a peak systolic velocity (PSV) of 260 cm/sec or more combined with an end diastolic velocity (EDV) of 70 cm/sec or more. RESULTS Over an 8-year period, 460 patients underwent CEA; 107 patients (23.3%) had an asymptomatic 50% to 99% contralateral ICA stenosis by standard criteria (PSV, >125 cm/sec) and an early postoperative duplex scan examination. Of these 107 patients, 38 patients (35.5%) had duplex scan criteria for 60% to 99% contralateral ICA stenosis. In these 38 patients, there was a mean postoperative PSV decrease of 47.7 cm/sec (10.1%) and a mean EDV decrease of 36.0 cm/sec (19.3%) in the ICA contralateral to the CEA. Eight of 38 (21.1%) preoperative contralateral 60% to 99% ICA lesions were reclassified as less than 60% on postoperative duplex scanning. Six of 69 (8.7%) preoperative lesions of less than 60% were reclassified as 60% to 99% on postoperative duplex scan. These six preoperative examinations were all close to the criteria for 60% to 99% stenosis (mean PSV, 232.5 cm/sec; mean EDV, 62.5 cm/sec). CONCLUSION One-fifth of patients with apparent 60% to 99% contralateral ICA lesions before the operation have less than 60% stenosis when restudied with duplex scan after unilateral CEA. Lesions below but near the cutoff for 60% to 99% may be reclassified as 60% to 99% on the postoperative duplex scan. These findings mandate that when duplex scanning is used as the sole imaging modality before CEA, patients with severe bilateral carotid stenosis must have an additional carotid duplex examination before operation on the second side.
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Affiliation(s)
- A M Abou-Zamzam
- Department of Surgery, Division of Vascular Surgery, Oregon Health Sciences University, and Portland Veterans Affairs Medical Center, Portland, OR 97201, USA
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Abstract
PURPOSE Finger ischemia caused by embolic occlusion of digital arteries originating from the palmar ulnar artery in a person repetitively striking objects with the heel of the hand has been termed hypothenar hammer syndrome (HHS). Previous reports have attributed the arterial pathology to traumatic injury to normal vessels. A large experience leads us to hypothesize that HHS results from trauma to intrinsically abnormal arteries. METHODS We reviewed the arteriography, histology, and clinical outcome of all patients treated for HHS in a university clinical research center study of hand ischemia, which prospectively enrolled more than 1300 subjects from 1971 to 1998. RESULTS Twenty-one men had HHS. All had occupational (mechanic, carpenter, etc) or avocational (woodworker) exposure to repetitive palmar trauma. All patients underwent upper-extremity and hand arteriography, unilateral in eight patients (38%) and bilateral in 13 patients (62%). By means of arteriogram, multiple digital artery occlusions were shown in the symptomatic hand, with either segmental ulnar artery occlusion in the palm or characteristic "corkscrew" elongation, with alternating stenoses and ectasia. Similar changes in the contralateral asymptomatic (and less traumatized) hand were shown by means of 12 of 13 bilateral arteriograms (92%). Twenty-one operations, consisting of segmental ulnar artery excision in the palm and vein grafting, were performed on 19 patients. Histology was compatible with fibromuscular dysplasia with superimposed trauma. Patency of arterial repairs at 2 years was 84%. One patient (5%) required amputative debridement of necrotic finger tips. No other tissue loss occurred. There have been no recurrences of ischemia in patients with patent bypass grafts. CONCLUSION To our knowledge, this is the largest reported group of HHS patients. The characteristic angiographic appearance, histologic findings, and striking incidence of bilateral abnormalities in patients with unilateral symptoms lead us to conclude that HHS occurs when persons with preexisting palmar ulnar artery fibrodysplasia experience repetitive palmar trauma. This revised theory for the etiology of HHS explains why HHS does not develop in most patients with repetitive palmar trauma.
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Affiliation(s)
- B L Ferris
- Division of Vascular Surgery, Department of Surgery, Oregon Health Sciences University, USA
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Abou-Zamzam AM, Moneta GL, Edwards JM, Yeager RA, McConnell DB, Taylor LM, Porter JM. Extrathoracic arterial grafts performed for carotid artery occlusive disease not amenable to endarterectomy. Arch Surg 1999; 134:952-6; discussion 956-7. [PMID: 10487589 DOI: 10.1001/archsurg.134.9.952] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESIS Extrathoracic cervical grafts are safe and provide long-lasting stroke prevention in patients with disease not amenable to standard carotid bifurcation endarterectomy. DESIGN Review of a prospectively maintained vascular surgical registry. SETTING Combined university and Department of Veterans Affairs vascular surgical service. PARTICIPANTS Patients requiring surgery for carotid atherosclerotic occlusive disease not amenable to endarterectomy from January 1988 to March 1998. INTERVENTIONS Carotid interposition grafting, subclavian-carotid bypass, or carotid-carotid bypass. MAIN OUTCOME MEASURES Perioperative stroke and death, and life-table determination of freedom from stroke, stroke-free survival, and graft patency. RESULTS Sixty patients (mean age, 65.8 years; range, 36-83) underwent cervically based carotid grafting. All had greater than 70% stenosis or occlusion of the innominate, common carotid, or internal carotid arteries, and 30 (50%) had undergone at least 1 previous ipsilateral carotid endarterectomy. Indication for operation was stroke or transient ischemic attack in 46 (77%) and asymptomatic high-grade stenosis in 14 (23%). Operative procedures included 31 (52%) carotid interposition grafts, 18 (30%) subclavian-carotid grafts, and 11 (18%) carotid-carotid grafts. Mean follow-up was 29 months (range, 1-117 months). Perioperative stroke rate was 5% (3/60) all in symptomatic patients, and there were no perioperative deaths. By life-table analysis, freedom from stroke was 92% at 1 and 5 years. Stroke-free survival was 90% at 1 year and 61% at 5 years. Primary graft patency was 94% at 1 year and 84% at 5 years, with assisted primary patency of 90% at 5 years. CONCLUSION Cervical carotid artery grafts for complicated or recurrent carotid atherosclerosis not amenable to endarterectomy are durable and provide excellent freedom from stroke with low perioperative morbidity and mortality.
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Affiliation(s)
- A M Abou-Zamzam
- Department of Surgery, Oregon Health Sciences University, Portland Veterans Affairs Medical Center, 97201, USA
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40
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Abstract
PURPOSE The use of vibrating tools has been shown to cause Raynaud's syndrome (RS) in a variety of workers, including those who use chain saws, chippers, and grinders. The diagnosis of RS in workers who use vibrating tools is difficult to document objectively. We studied a patient cohort with RS caused by the use of a vibrating pneumatic air knife (PAK) for removal of automobile windshields and determined our ability to document RS in these workers by means of digital hypothermic challenge testing (DHCT), a vascular laboratory study that evaluates digital blood pressure response to cooling. METHODS Sixteen male autoglass workers (mean age, 36 years) with RS were examined by means of history, physical examination, arm blood pressures, digital photoplethysmography, screening serologic studies for underlying connective tissue disorder, and DHCT. RESULTS No patient had RS before they used a PAK. The mean onset of RS (color changes, 100%; pain, 93%; parathesias, 75%) with cold exposure was 3 years (range, 1.5 to 5 years) after initial PAK use (mean estimated PAK use, 2450 hours). Fifty-six percent of workers smoked cigarettes. The findings of the physical examination, arm blood pressures, digital photoplethysmography, and serologic testing were normal in all patients. At 10 degrees C cooling with digital cuff and patient cooling blanket, a significant decrease in digital blood pressure was shown by means of DHCT in 100% of test fingers versus normothermic control fingers (mean decrease, 75%; range, 25% to 100%; normal response, less than 17%; P <.001). The mean follow-up period was 18 months (range, 1 to 47 months). No patient continued to use the PAK, but symptoms of RS were unchanged in 69% and worse in 31%. CONCLUSION PAK use is a possible cause of vibration-induced RS. The presence of RS in workers who use the PAK was objectively confirmed by means of DHCT. Cessation of PAK use in the short term did not result in symptomatic improvement.
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Affiliation(s)
- R B McLafferty
- Division of Vascular Surgery, Department of Surgery, Oregon Health Sciences University, Portland, OR 97201, USA
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41
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Yeager RA, Taylor LM, Moneta GL, Edwards JM, Nicoloff AD, McConnell DB, Porter JM. Improved results with conventional management of infrarenal aortic infection. J Vasc Surg 1999; 30:76-83. [PMID: 10394156 DOI: 10.1016/s0741-5214(99)70178-3] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Interest in alternative methods, such as autogenous vein grafts and aortic allografts, for the management of infrarenal aortic infection (IRAI) has been stimulated by the historically disappointing results with conventional surgical management. Recently, there have been dramatic improvements in the results of axillofemoral bypass grafting (AXFB) followed by excision of the IRAI that have gone relatively unrecognized. The purpose of this report is the presentation of modern-day results in the treatment of IRAI with conventional surgical methods. METHODS From January 1, 1983, through June 30, 1998, patients with IRAI underwent treatment with AXFB and complete excision of the IRAI. The patients were followed for survival, limb salvage, and AXFB graft patency. The results were tabulated with life-table methods. RESULTS During the 15-year study period, 60 patients (51 men, nine women; mean age, 68 years) underwent treatment for IRAI (50 graft infections, including 16 graft-enteric fistulae, and 10 primary aortic infections). The mean follow-up period was 41 months. The perioperative mortality rate was 13% (12% for graft infection, and 20% for primary infection). The overall 2-year and 5-year survival rates were 67% and 47%, respectively. The limb salvage rates at 2 and 5 years were 93% and 82%, respectively. The 5-year primary AXFB graft patency rate was 73%. CONCLUSION These results show an improvement with the conventional management of IRAI equal or superior to those results reported with alternative methods, including femoral vein grafts or aortic allografts. These results should be regarded as the modern standard with which alternative therapies can be compared.
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Affiliation(s)
- R A Yeager
- Division of Vascular Surgery, Department of Surgery, Oregon Health Sciences University, Portland Veteran's Affairs Medical Center, Portland, OR 98207, USA
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Abstract
In three experiments, children aged between 4 and 7 years viewed a circular disc oriented at a slant. The disc was made of luminous material and situated in a darkened chamber. Children of all ages exaggerated the circularity of the disc when they knew that the object was really a circle (the circle task), and the effect was greatest in the younger members of the sample. Crucially, however, a group of children in Experiment 3 who viewed an identical shape that they knew emanated from an actual ellipse did not exaggerate circularity. In the second experiment, children tackled three standard theory of mind tasks in addition to the circle task mentioned above. A significant correlation emerged (even with age partialed) between the extent of exaggeration made by those who knew that the shape was a circle and ability to pass the theory of mind tests. It seems knowledge of reality contaminates judgements of appearance in the circle task. This might be the same bias that features in realist errors in theory of mind tasks.
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Affiliation(s)
- P Mitchell
- School of Psychology, University of Nottingham, UK.
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43
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Landry GJ, Moneta GL, Taylor LM, McLafferty RB, Edwards JM, Yeager RA, Porter JM. Duplex scanning alone is not sufficient imaging before secondary procedures after lower extremity reversed vein bypass graft. J Vasc Surg 1999; 29:270-80; discussion 280-1. [PMID: 9950985 DOI: 10.1016/s0741-5214(99)70380-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Duplex surveillance of lower extremity reversed vein bypass grafts (LERVG) is a means of identifying patients at risk for occlusion. The perceived accuracy of duplex scan as a means of identifying stenoses has led many surgeons to perform graft revision on the basis of duplex scan alone. This may result in missing additional lesions that are threatening patency. To assess the role of duplex scan as the sole imaging method before revision of LERVGs, we reviewed consecutive patients undergoing revisions who underwent preoperative arteriography after identification of duplex scan abnormalities. METHODS Duplex scan results, operative reports, and preoperative arteriograms for patients undergoing LERVG revision from January 1990 to December 1997 were reviewed. A standard duplex scan surveillance protocol was followed, and attempts were made to survey the entire graft, including inflow and outflow. Duplex scan results were compared with the results of preoperative arteriograms and the operation performed to determine if all significant lesions were identified by means of duplex scan alone. RESULTS Two hundred five LERVG revisions were performed. The 5-year assisted primary patency rate was 91%. In 119 cases (58%), arteriography did not contribute significantly to duplex scan findings. Arteriography significantly contributed to operative planning in 86 cases (42%). In 38 cases (19%), only a low-flow state was identified by means of duplex scan, and a correctable stenosis was identified by means of arteriography. In 48 cases (23%), additional significant lesions corrected at operation were identified by means of arteriography. These included 26 inflow, 16 graft, and 8 outflow lesions. Arteriography was most useful as a means of determining the revision procedure performed when there were inflow lesions (P <.05) or when the proximal anastomosis was to the profunda or superficial femoral arteries (P <.05). All frequently performed bypass graft configurations had some discrepancy between arteriographic and duplex scan findings. CONCLUSION Available data do not permit prediction of which LERVG are immune from missed lesions in a duplex scan surveillance protocol. This suggests to us that arteriography is mandatory before LERVG revisions.
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Affiliation(s)
- G J Landry
- Division of Vascular Surgery, Oregon Health Sciences University, Portland, USA
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44
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Taylor LM, Moneta GL, Sexton GJ, Schuff RA, Porter JM. Prospective blinded study of the relationship between plasma homocysteine and progression of symptomatic peripheral arterial disease. J Vasc Surg 1999; 29:8-19; discussion 19-21. [PMID: 9925456 DOI: 10.1016/s0741-5214(99)70345-9] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE An elevated plasma homocysteine level is an established risk factor for atherosclerotic coronary heart disease (CHD), cerebrovascular disease (CVD), and lower extremity occlusive disease (LED). An elevated plasma homocysteine level can be reduced by therapy with folate and vitamins B6 and B12. An accurate evaluation of the role of vitamin therapy requires knowledge of the influence of plasma homocysteine levels on the progression of CHD, CVD, and LED. METHODS The Homocysteine and Progression of Atherosclerosis Study is a blinded prospective study of the influence of homocysteine and of other atherosclerotic risk factors on the progression of disease in patients with symptomatic CVD, LED, or both. This study is set in a university hospital vascular surgery clinic and the General Clinical Research Center. Consecutive patients with stable symptomatic CVD or LED underwent baseline clinical, laboratory, and vascular laboratory testing for homocysteine and other risk factors and were examined every 6 months. The primary endpoints were ankle brachial pressure index, duplex scan-determined carotid stenosis, and death. The secondary endpoints were the clinical progressions of CHD, LED, and CVD. The hypothesis that was tested was whether the progression of symptomatic CVD or LED was more frequent or more rapid in patients with elevated plasma homocysteine levels. plasma homocysteine levels. RESULTS After a mean follow-up period of 37 months (range, 1 to 78 months) for deaths from all causes (>14 micromol/L; elevated, 18.6%; normal, 9.4%; P = .022), deaths from cardiovascular disease (elevated, 12.5%; normal, 6.3%; P = .05) and the clinical progression of CHD (highest 20% of homocysteine levels, 80%; lowest 20% of homocysteine levels, 39%; P = .007) were significantly more frequent or more rapid by life-table analysis when the homocysteine levels were elevated. Multivariate Cox proportional hazards regression model showed a significant independent and increasing relationship between the plasma homocysteine levels and the time to death (relative risk for highest one third of homocysteine values, 1.6; 95% confidence interval [CI], 1.04 to 2.56; P = 029; and relative risk for highest one fifth of homocysteine values, 3.13; 95% CI, 1.69 to 6.64; P = .0001). After an adjustment for age, smoking, hypertension, diabetes, cholesterol, and the vascular laboratory progression of CVD or LED, each 1.0 micromol/L increase in the plasma homocysteine levels resulted in a 3.6% increase (95% CI, 0.0% to 6.6%; P = .06) in the risk of death (all causes) at 3 years and a 5.6% increase (95% CI, 2.2% to 8.5%; P = .003) in the risk of death from cardiovascular disease. CONCLUSION We conclude that elevated plasma homocysteine levels are associated significantly with death, with death from cardiovascular disease, and with the progression of CHD in patients with symptomatic CVD or LED. These results strongly mandate clinical trials of homocysteine-lowering vitamin therapy in such patients.
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Affiliation(s)
- L M Taylor
- Division of Vascular Surgery, and the General Clinical Research Center,Oregon Health Sciences University, Portland 97201, USA
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45
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Nehler MR, Taylor LM, Porter JM. Iatrogenic vascular trauma. Semin Vasc Surg 1998; 11:283-93. [PMID: 9876035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
With the increasing performance of percutaneous transluminal angioplasty and insertion of an increasing number of intravascular devices, the size of arterial punctures has been increasing. A consistent minority of these procedures will result in vascular injuries requiring treatment. At the same time, the regionalized nature of trauma care in the United States has resulted in a large number of vascular surgeons who are exposed to vascular trauma only when iatrogenic. The most common injuries observed are caused by percutaneous vascular instrumentation and include hemorrhage and pseudoaneurysm that may compress adjacent structures, fistula, acute occlusion, and embolization. Injuries unique to balloon angioplasty/stenting include arterial rupture and dissection. Indwelling intravascular devices are another common source of iatrogenic vascular injury ranging from arterial rupture to thrombosis and embolization. Much less common injuries are observed in orthopedic and abdominal/laparoscopic operations but show reproducible causes/patterns. Finally, pediatric iatrogenic vascular trauma is relatively common because of the small size of the vasculature, but the natural history and management is markedly different from that in adults.
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Affiliation(s)
- M R Nehler
- Department of Surgery, University of Colorado Health Sciences Center, Denver, USA
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46
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Lam EY, McLafferty RB, Taylor LM, Moneta GL, Edwards JM, Barton RE, Petersen B, Porter JM. Inferior epigastric artery pseudoaneurysm: a complication of paracentesis. J Vasc Surg 1998; 28:566-9. [PMID: 9737471 DOI: 10.1016/s0741-5214(98)70147-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Two patients had inferior epigastric artery pseudoaneurysms after therapeutic paracentesis for ascites caused by portal hypertension. The first patient, a 62-year-old man, had a two-week history of left lower quadrant pain, tenderness, and nonpulsatile mass after a paracentesis for ascites. A left inferior epigastric artery pseudoaneurysm measuring 10 cm in diameter and 20 cm in length was diagnosed by means of Duplex ultrasound and arteriography. The patient was treated with percutaneous embolization, with successful thrombosis of the pseudoaneurysm. The second patient, a 33-year-old woman, had a six-week history of left lower quadrant pain, tenderness, and nonpulsatile mass after a paracentesis for ascites. Computerized tomography and arteriography showed a left inferior epigastric artery pseudoaneurysm, measuring 7 cm in diameter and 9 cm in length. The patient was treated with percutaneous embolization with successful thrombosis of the pseudoaneurysm. Both patients were discharged in good condition 2 days after embolization. Inferior epigastric artery pseudoaneurysm is a complication of paracentesis, and percutaneous embolization may be preferable to surgical repair in patients with chronic liver failure and portal hypertension.
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Affiliation(s)
- E Y Lam
- Department of Surgery, Dotter Interventional Institute, Oregon Health Sciences University, Portland, USA
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47
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Williamson WK, Abou-Zamzam AM, Moneta GL, Yeager RA, Edwards JM, Taylor LM, Porter JM. Prophylactic repair of renal artery stenosis is not justified in patients who require infrarenal aortic reconstruction. J Vasc Surg 1998; 28:14-20; discussion 20-2. [PMID: 9685126 DOI: 10.1016/s0741-5214(98)70195-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Simultaneous prophylactic repair of asymptomatic renal artery stenosis (ARAS) in patients who require infrarenal aortoiliac reconstruction is controversial. This study documents the natural history of ARAS in patients who require aortic reconstruction. METHODS Two hundred patients who required aortic reconstruction from 1985 to 1990 for indications other than hypertension or renal salvage were identified. ARAS was not repaired. Preoperative angiograms were available for 171 of 200 patients and were reviewed for renal artery stenosis. Patients were assessed for atherosclerotic risk factors, survival, preoperative and follow-up blood pressure, serum creatinine level, antihypertensive medication usage, and need for dialysis. RESULTS The mean duration of follow-up was 6.3 years. Twenty-four of 171 patients (14%) had preoperative unilateral 70% to 99% diameter reduction ARAS, and eight (5%) had bilateral 70% to 99% ARAS. Clinical features associated with > or =70% ARAS included coronary artery disease, increased age, and a diagnosis of hypertension (p < 0.05). Patients with > or =70% ARAS did not have a decreased 7-year survival rate (66% vs 84%; p = 0.10) but had higher systolic blood pressures (153 +/- 25 vs 138 +/- 30 mm Hg; p < 0.05) as well as increased numbers of antihypertensive medications at follow-up (1.1 +/- 0.2 vs 0.7 +/- 1; p < 0.05). The mean serum creatinine level (1.1 +/- 0.3 preoperative vs 1.4 +/- 0.8 mg/dl; p = NS) was not increased. One patient (0.58%) with polycystic kidney disease and minimal renal artery stenosis required dialysis. CONCLUSIONS High-grade ARAS in patients who are undergoing infrarenal aortic reconstruction is associated at late follow-up with increased systolic blood pressure and a need for increased numbers of antihypertensive medications, but not decreased survival rate, dialysis dependence, or an increase in serum creatinine level. These data do not support renal artery repair in patients with ARAS who undergo infrarenal aortic reconstruction.
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Affiliation(s)
- W K Williamson
- Department of Surgery, Oregon Health Sciences University and Portland Department of Veterans Affairs Hospital, 97201, USA
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48
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Abstract
PURPOSE This report details our experience with common femoral artery resection and Dacron interposition grafting in the management of vascular reoperations involving the common femoral artery. DESIGN Retrospective review. SETTING University teaching hospital. SUBJECTS Consecutive reoperative patients who had common femoral artery interposition grafting for arteriosclerotic occlusive disease from 1986 to 1997. INTERVENTIONS Common femoral artery resection and interposition grafting. MAIN OUTCOME MEASURES Operative morbidity and mortality rates and long-term patency, limb salvage, patient survival, freedom-from-graft-infection, and freedom-from-reoperation rates. RESULTS Ninety-nine common femoral arteries (16 bilateral) were resected and replaced with Dacron interposition grafts in 83 patients (50 male, 33 female; mean age, 65 years) who had had 237 previous ipsilateral common femoral artery operations (mean, 2.4 operations; range, 1-9 operations). Simultaneous infrainguinal bypass grafts were performed in 52 operations (53%), and 60 operations (61%) were performed in patients who had had previous ipsilateral proximal bypass grafts. Operative mortality was 2%, with a 14% rate of perioperative wound complications. Mean follow-up time was 22 months. One- and 3-year assisted primary patency rates for the interposition grafts were 90% and 77%, respectively. Both 1- and 3-year life-table-determined limb salvage rates were 95%. One- and 3-year life-table-determined freedom-from-reoperation rates were 74% and 43%, respectively. One- and 3-year life-table-determined freedom-from-infection rates were 99% and 92%, respectively. One- and 3-year life-table-determined survival rates were 82% and 73%, respectively. CONCLUSIONS Common femoral artery resection and Dacron interposition grafting are safe, and they obviate many difficulties associated with reoperative common femoral artery surgery with satisfactory long-term results.
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Affiliation(s)
- M R Nehler
- Department of Surgery, University of Colorado Health Sciences Center, Denver 80262, USA
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49
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Abstract
BACKGROUND We report results of infected aortic aneurysms treated by a single group over 20 years. METHODS Retrospective review. RESULTS Seventeen patients were treated, 10 with infrarenal and 7 suprarenal infections. All had abdominal/back pain, 88% were febrile, 71% had leukocytosis, and 24% were hemodynamically unstable. The most common responsible organism was Staphylococcus aureus (29%) followed by Salmonella organisms (24%). All suprarenal infections were gram-positive organisms. Infrarenal infections were treated with preliminary axillofemoral bypass followed by aortic resection. Suprarenal infections were treated with either in situ prosthetic graft or patch repairs. Operative survival was 90% for infrarenal and 57% for suprarenal infections. Operative deaths occurred in the setting of overwhelming sepsis and/or severe preoperative hemodynamic instability. There was no limb loss, renal failure, or intestinal ischemia. Late deaths occurred in 4 patients at 1.3 to 6.3 years postoperatively and were unrelated to their aortic repairs. Nine patients remain alive with a median follow-up of 2 years. There have been no late aortic or graft infections. CONCLUSIONS In the absence of hemodynamic instability and uncontrolled sepsis, infected aortic aneurysms can be successfully repaired with durable results.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/mortality
- Aneurysm, Infected/surgery
- Aortic Aneurysm, Abdominal/microbiology
- Aortic Aneurysm, Abdominal/mortality
- Aortic Aneurysm, Abdominal/surgery
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/mortality
- Aortic Aneurysm, Thoracic/surgery
- Bacteria/isolation & purification
- Emergencies
- Female
- Humans
- Male
- Middle Aged
- Retrospective Studies
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Affiliation(s)
- G L Moneta
- Department of Surgery, Oregon Health Sciences University and Portland Department of Veteran's Affairs Hospital, 97201-3098, USA
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Yeager RA, Moneta GL, Edwards JM, Williamson WK, McConnell DB, Taylor LM, Porter JM. Predictors of outcome of forefoot surgery for ulceration and gangrene. Am J Surg 1998; 175:388-90. [PMID: 9600284 DOI: 10.1016/s0002-9610(98)00045-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surprisingly little is known about the long-term outcome of forefoot surgery for limb salvage. METHODS From January 1, 1992 through December 31, 1996, patients requiring toe amputation or forefoot surgery were prospectively entered into a computerized database and followed up for healing, need for repeat foot surgery, or major amputation (below or above knee). RESULTS A total of 162 patients (mean age 65 years), 72% diabetic, 10% with end-stage renal disease (ESRD), and 73% without palpable pulses, were entered into the study. Mean follow-up was 25 months. Of patients without palpable pulses (n = 98), 83% underwent concomitant or subsequent limb revascularization. Eleven of 98 revascularization procedures (11%) were hemodynamically unsuccessful. Nonhealing of the initial forefoot procedure occurred in 14%, and late repeat foot surgery (following initial healing) was required in an additional 14%. Major amputation was eventually required in 30 (18.5%) patients. Multivariate analysis indicated that unsuccessful revascularization, but not diabetes or ESRD, predicted nonhealing and major amputation (P <0.0001). Patients presenting with palpable pulses and neuropathic ulcers were at risk for late, repeat foot surgery, but not major amputation (P = 0.0015). CONCLUSIONS In patients requiring toe or partial forefoot amputation, success of revascularization is the primary predictor of initial healing and freedom from major amputation. Neuropathic ulceration predicts need for repeat foot surgery following healing.
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Affiliation(s)
- R A Yeager
- Portland Department of Veteran's Affairs Medical Center, Department of Surgery, Oregon Health Sciences University, 97207, USA
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