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LaLonde L, Neenan A, Byrd M, Hoodin F, Bouma S, Choi SW. Caregiver self-efficacy providing nutritional support for pediatric patients undergoing hematopoietic stem cell transplant is associated with psychosocial factors. Front Nutr 2024; 11:1323482. [PMID: 38487626 PMCID: PMC10937416 DOI: 10.3389/fnut.2024.1323482] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Caregiver self-efficacy in providing nutritional support to pediatric hematopoietic stem cell transplantation (HSCT) patients has been little studied despite the increased risk of these children potentially being over- or under-nourished after HSCT, and nutritional status could possibly affect treatment outcomes. The current study aimed to describe caregiver dietary self-efficacy and its associated psychosocial factors and barriers to following dietary recommendations. Methods Caregivers completed questionnaires pre-HSCT and 30 days, 100 days, and one year post-HSCT. A subset provided a 24-h recall of food intake. Results Results showed generally high caregiver confidence and low difficulty supporting their child nutritionally. However, lower confidence was associated with higher caregiver depression, anxiety, and stress 30 days post-HSCT. Further, higher difficulty at various time points was correlated with lower income, higher depression and anxiety, stress, and miscarried helping (i.e., negative caregiver-child interactions surrounding eating), as well as child overweight status and failure to meet protein intake guidelines. Nutritional criteria for protein, fiber, added sugar, and saturated fat were met by 65%, 0%, 75%, and 75%, respectively. Caregiver attitudes and child behavior were the most frequently reported barriers to healthy eating. Discussion Results suggest that directing resources to caregivers struggling emotionally, economically, or transactionally could support pediatric patients undergoing HSCT in maintaining optimal nutritional status.
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Affiliation(s)
- Leah LaLonde
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, United States
- Department of Psychology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Alexandra Neenan
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, United States
| | - Michelle Byrd
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, United States
| | - Flora Hoodin
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, United States
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Sandra Bouma
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, United States
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Gokdemir Y, Eralp EE, Ergenekon AP, Yilmaz Yegit C, Yanaz M, Mursaloğlu H, Uzunoglu B, Kocamaz D, Tastan G, Kenis Coskun O, Filbrun A, Enochs C, Bouma S, Iwanicki C, Karakoc F, Nasr SZ, Karadag B. Implementation of standardized cystic fibrosis care algorithm to improve the center data-quality improvement project international collaboration. J Cyst Fibros 2023; 22:710-714. [PMID: 37037703 DOI: 10.1016/j.jcf.2023.03.016] [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] [Received: 07/19/2022] [Revised: 02/26/2023] [Accepted: 03/26/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND A collaboration between the University of Michigan (U of M) Cystic Fibrosis Center (CFC) and Marmara University (MU) CFC was initiated to improve the health status of people with cystic fibrosis (pwCF) at MU through implementing Quality Improvement (QI) initiatives. The main aim was to improve lung function in children with FEV1pp <80. The secondary aim was to assess the changes in health related quality of life. METHODS Included in the project were pwCF who received cystic fibrosis (CF) care at the MU CFC and were 6-18 years of age with an FEV1pp <80. Flow charts were created and a standardized CF care algorithm was implemented. Weekly case review were done to develop individualized treatment plans. Appropriate intervention was applied and patient data were assessed at baseline, 3, 6, 9 and 12 months. The Cystic Fibrosis Revised Questionnaire (CFQ-R) was completed. RESULTS 55 pwCF were included (mean age:11.8 ± 3.3 years). Mean FEV1pp (SD) at baseline, 6 and 12 month was 63.7 (14.6), 66.9 (16.6), 70.4 (19.2), respectively, with a relative increase of 5.0% in 6 months (p:0.002) and 10.5% in 12 months compared to baseline (p<0.001). Physical functioning, eating problems and respiratory symptoms domains of the CFQ-R questionnaire were improved at the end of the one year for 6-13 (p = 0.024, p = 0.009, p = 0.002) and 13-18 year olds (p = 0.013, p = 0.002, p = 0.038). CONCLUSION There was significant improvement in pwCF with FEV1<80%pp after implementing this QI project. The processes and assessments used can be adopted by other low-middle income countries to improve similar measures.
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Affiliation(s)
- Yasemin Gokdemir
- Marmara University School of Medicine, Division of Pediatric Pulmonology, Mimar Sinan Cad. No:10, Istanbul 34899, Turkey.
| | - Ela Erdem Eralp
- Marmara University School of Medicine, Division of Pediatric Pulmonology, Mimar Sinan Cad. No:10, Istanbul 34899, Turkey
| | - Almala Pinar Ergenekon
- Marmara University School of Medicine, Division of Pediatric Pulmonology, Mimar Sinan Cad. No:10, Istanbul 34899, Turkey
| | - Cansu Yilmaz Yegit
- Marmara University School of Medicine, Division of Pediatric Pulmonology, Mimar Sinan Cad. No:10, Istanbul 34899, Turkey
| | - Muruvvet Yanaz
- Marmara University School of Medicine, Division of Pediatric Pulmonology, Mimar Sinan Cad. No:10, Istanbul 34899, Turkey
| | - Hakan Mursaloğlu
- Marmara University School of Medicine, Division of Pediatric Pulmonology, Mimar Sinan Cad. No:10, Istanbul 34899, Turkey; King's College Hospital, Department of Emergency Medicine, London, England, United Kingdom
| | - Burcu Uzunoglu
- Marmara University School of Medicine, Division of Pediatric Pulmonology, Mimar Sinan Cad. No:10, Istanbul 34899, Turkey
| | - Damla Kocamaz
- Marmara University School of Medicine, Division of Pediatric Pulmonology, Mimar Sinan Cad. No:10, Istanbul 34899, Turkey
| | - Gamze Tastan
- Marmara University School of Medicine, Division of Pediatric Pulmonology, Mimar Sinan Cad. No:10, Istanbul 34899, Turkey
| | - Ozge Kenis Coskun
- Marmara University School of Medicine, Department of Physical Therapy and Rehabilitation, Istanbul, Turkey
| | - Amy Filbrun
- Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, United States.
| | - Catherine Enochs
- Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, United States.
| | - Sandra Bouma
- Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, United States.
| | - Courtney Iwanicki
- Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, United States.
| | - Fazilet Karakoc
- Marmara University School of Medicine, Division of Pediatric Pulmonology, Mimar Sinan Cad. No:10, Istanbul 34899, Turkey
| | - Samya Z Nasr
- Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, United States.
| | - Bulent Karadag
- Marmara University School of Medicine, Division of Pediatric Pulmonology, Mimar Sinan Cad. No:10, Istanbul 34899, Turkey
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Gokdemir Y, Eralp EE, Ergenekon AP, Yegit CY, Yanaz M, Mursaloglu H, Uzunoglu B, Kocamaz D, Tastan G, Filbrun A, Enochs C, Bouma S, Iwanicki C, Karakoc F, Nasr SZ, Karadag B. Improvements in body mass index of children with cystic fibrosis following implementation of a standardized nutritional algorithm: A quality improvement project. Pediatr Pulmonol 2023; 58:1463-1470. [PMID: 36747482 DOI: 10.1002/ppul.26344] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 01/24/2023] [Accepted: 02/05/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND A collaboration between the University of Michigan (UM) Cystic Fibrosis Center (CFC) and Marmara University (MU) CFC was initiated in MU through conducting Quality Improvement projects (QIP). The global aim was to improve nutritional status of children with CF (cwCF), with a specific aim to increase the mean BMI percentile (BMIp) for cwCF by 10 percentile points in 12 months. METHODS Body mass index (BMI) percentiles of cwCF were categorized as: nutritionally adequate (BMIp ≥ 50%); at risk (BMIp 25%-49%); urgently at risk (BMIp 10%-25%); critically at risk (BMIp < 10%). Appropriate interventions were made according to BMIp category every three months. Forced expiratory volume in one-second percent predicted (FEV1pp), and health-related quality of life (HRQoL) were evaluated. RESULTS One hundred and eight-two cwCF with a mean age of 9.1 ± 4.3 years were included in the project. Baseline BMIp increased from 25.6 to 37.2 at the 12th month (p < 0.001). In the critically at-risk group BMIp increased from 3.6 to 20.5 (p < 0.001), in the urgently at risk group from 15.9 to 30.8 (p < 0.001), in the at risk group from 37.0 to 44.2 (p < 0.079) and in the nutritionally adequate group the increase was from 66.8 to 69.5 (p < 0.301). FEV1pp also improved significantly, from 81.3 ± 20.6 to 85.9 ± 20.8 (p < 0.001). Physical functioning, eating problems, and respiratory symptoms domains of the HRQoL evaluation improved (p < 0.05). CONCLUSION This project has led to significant improvements in BMIp, FEV1pp and HRQoL of cwCF; similar projects could easily be implemented by centers in other developing countries.
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Affiliation(s)
- Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Almala Pinar Ergenekon
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Cansu Yilmaz Yegit
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Muruvvet Yanaz
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Hakan Mursaloglu
- Department of Emergency Medicine, King's College Hospital, London, UK
- Marmara University School of Medicine, Selim Coremen Cystic Fibrosis Center, Istanbul, Turkey
| | - Burcu Uzunoglu
- Marmara University School of Medicine, Selim Coremen Cystic Fibrosis Center, Istanbul, Turkey
| | - Damla Kocamaz
- Marmara University School of Medicine, Selim Coremen Cystic Fibrosis Center, Istanbul, Turkey
| | - Gamze Tastan
- Marmara University School of Medicine, Selim Coremen Cystic Fibrosis Center, Istanbul, Turkey
| | - Amy Filbrun
- Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, USA
| | - Catherine Enochs
- Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sandra Bouma
- Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, USA
| | - Courtney Iwanicki
- Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, USA
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Samya Z Nasr
- Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, USA
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
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Iwanicki C, Andrews H, Fogarty-Brown S, Enochs C, Bouma S, Nasr S. 374 Optimizing screening for food insecurity in a pediatric cystic fibrosis center. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Nasr SZ, Gökdemir Y, Erdem E, Karakoc F, Ergenekon P, Tapley C, Dagher S, Bouma S, Coşkun ÖK, Kocamaz D, Karadag B. Collaboration between two CF centers; one in USA and one in Turkey before and during CoV2 pandemic. Pediatr Pulmonol 2022; 57:2553-2557. [PMID: 35759419 DOI: 10.1002/ppul.26041] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 06/02/2022] [Accepted: 06/17/2022] [Indexed: 11/09/2022]
Abstract
To address the discrepancy in the quality of care and outcomes between cystic fibrosis centers (CFCs) in high-income countries and limited resources countries (LRCs), a collaboration between our team at the University of Michigan CFC (UMCFC) and a CF center in Turkey (Marmara University CFC [MUCFC], Istanbul) was established. The collaboration included evaluation of all aspects of care and initiation of quality improvement (QI) measures. Teaching and implementing QI tools has led to start of improvement in MUCFC care. Close monitoring and sharing resources like UMCFC algorithms, protocols, and QI processes were done.
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Affiliation(s)
- Samya Z Nasr
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Yasemin Gökdemir
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Ela Erdem
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Fazilet Karakoc
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Pinar Ergenekon
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Christopher Tapley
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Sharyn Dagher
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Sandra Bouma
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Özge Keniş Coşkun
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Damla Kocamaz
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Bulent Karadag
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
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Nasr S, Gökdemir Y, Eralp EE, Karakoc F, Ergenekon P, Tapley C, Dagher S, Bouma S, Cosşkun ÖK, Kocamaz D, Karakoc F. 83: CF Global Care: Continuation of the collaboration between 2 CF centers; University of Michigan, USA, and Marmara University, Istanbul, Turkey, in the COVID-19 pandemic. J Cyst Fibros 2021. [PMCID: PMC8518439 DOI: 10.1016/s1569-1993(21)01508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gökdemir Y, Eralp EE, Ergenekon P, Yegit CY, Mursaloglu H, Uzunoglu B, Kocamaz D, Taştan G, Filbrun A, Enochs C, Bouma S, Iwanicki C, Karakoc F, Nasr S, Karadag B. 108: Change in FEV1 after implementation of standardized CF care algorithm: A quality improvement project. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01533-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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8
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Adair D, Hider A, Tapley C, Filbrun A, Bouma S, Iwanicki C, Nasr S. 121: Assessing the utility of an outpatient exercise program for patients with CF: A quality improvement project. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Adair D, Hider A, Filbrun AG, Tapley C, Bouma S, Iwanicki C, Nasr SZ. Assessing the Utility of an Outpatient Exercise Program for Children With Cystic Fibrosis: A Quality Improvement Project. Front Pediatr 2021; 9:734292. [PMID: 35096701 PMCID: PMC8793844 DOI: 10.3389/fped.2021.734292] [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] [Received: 06/30/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022] Open
Abstract
Children with cystic fibrosis (CF) (cwCF) suffer from inadequate weight gain, failure to thrive, and muscle weakness. The latter may be secondary to disuse atrophy (muscle wasting or reduction in muscle size associated with reduced physical activity and inflammation). Handgrip strength (HGS) is a reliable surrogate for muscle strength and lean body mass. Data from our CF center have shown an association between low HGS and forced expiratory volume in 1 s (FEV1) in cwCF. High-intensity interval training (HIIT) improves physical strength. Therefore, we devised a project to assess implementing a HIIT exercise program in the home setting, in order to improve physical strength in cwCF with HGS ≤ 50th percentile. Patients were instructed to complete 3-5 sessions of HIIT exercises per week. Wilcoxon matched-pairs signed-rank tests were used to compare HGS, FEV1, and body mass index (BMI) percentile at baseline and at a follow-up clinic visit. Follow-up was limited due to the COVID pandemic. Adherence to the HIIT regimen was poor. A total of twenty-nine cwCF participated in the program. However, a total of 13 individuals reported some form of moderate activity at follow-up and therefore constituted our final study population. There was a statistically significant increase in absolute grip strength (AGS) and FEV1 for these individuals. Even though the home HIIT protocol was not followed, the project demonstrated that moderate physical activity in cwCF can lead to significant improvement in HGS and overall physical strength.
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Affiliation(s)
- Dionne Adair
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, MI, United States
| | - Ahmad Hider
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Amy G Filbrun
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, MI, United States
| | - Chris Tapley
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, MI, United States
| | - Sandra Bouma
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, MI, United States
| | - Courtney Iwanicki
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, MI, United States
| | - Samya Z Nasr
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, MI, United States
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Nasr S, Filbrun A, Enochs C, Caverly L, Stiffler J, Vess T, Rajala K, Lehrmann J, Iwanicki C, Bouma S, Tales K, Tapley C, Fenner B. P191 Quality improvement project to improve pulmonary function in paediatric cystic fibrosis patients. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30485-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
BACKGROUND Malnutrition is a significant problem for hospitalized patients in the United States. Nutrition assessment is an important step in recognizing malnutrition; however, it is not always performed using consistent parameters. METHODS A survey among U.S. American Society for Parenteral and Enteral Nutrition (ASPEN) members was conducted to collect data on nutrition assessment parameters used in hospitals and to establish how facilities use their electronic health record (EHR) to permit data retrieval and outcome reporting. RESULTS The survey was developed by the ASPEN Malnutrition Committee and was sent to 5487 U.S. ASPEN members, with 489 responding for a 9% response rate. Ninety-eight percent of adult and 93% of pediatric respondents indicated a registered dietitian completed the nutrition assessment following a positive nutrition screen. Variables most frequently used among adult respondents included usual body weight, ideal body weight, and body mass index. Among pediatric respondents, weight-for-age and height-for-age percentiles and length/height-for-age percentile were most frequently used. Both adult and pediatric respondents indicated use of physical assessment parameters, including muscle and fat loss and skin assessment. Eighty-seven percent of adult and 77% of pediatric respondents indicated they are using the Academy of Nutrition and Dietetics (Academy) and ASPEN Consensus Malnutrition Characteristics for Adult and Pediatric Malnutrition, respectively. Overall, 97% of respondents indicated nutrition assessment documentation was completed via an EHR. Of all respondents, 61% indicated lack of clinical decision support within their EHR. CONCLUSION This survey demonstrated significant use of the Academy/ASPEN malnutrition consensus characteristics.
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Affiliation(s)
- Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sandra Bouma
- Pediatric Cystic Fibrosis and Gastrointestinal Clinics, C.S. Mott Children's Hospital, University of Michigan Health System Michigan Medicine, Ann Arbor, Michigan
| | | | - Vincent W Vanek
- Mercy Health Youngstown Region, St. Elizabeth Youngstown Hospital, Youngstown, Ohio
| | | | - Sadeq A Quraishi
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Peggi Guenter
- Clinical Practice, Quality, and Advocacy, American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland
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Bouma S, Peterson M, Gatza E, Choi SW. Nutritional status and weakness following pediatric hematopoietic cell transplantation. Pediatr Transplant 2016; 20:1125-1131. [PMID: 27770486 DOI: 10.1111/petr.12821] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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] [Accepted: 09/06/2016] [Indexed: 12/12/2022]
Abstract
Survivorship after pediatric HCT has increased over the past decade. Focus on long-term care and well-being remains critical due to risk of poor dietary habits and exaggerated sedentary behavior, which can lead to muscle weakness, increased risk for obesity, and cardiometabolic disorders. Nutrition and physical activity are key factors in survivorship; however, data are limited. Comprehensive nutritional assessments, including nutrition-focused physical examination, grip strength, and food/activity surveys, were completed in 36 pediatric HCT survivors (aged 2-25 years). Patients were divided into undernutrition, normal-nutrition, and overnutrition categories. Fifty percent of participants were classified as normal nutrition, 22% undernutrition, and 28% overnutrition. Few patients met the U.S. Dietary Guidelines recommended intake for vegetables, fiber, saturated fat, and So FAS. Patients in the undernutrition group demonstrated significantly lower grip strength than those in the normal- and overnutrition groups. When grip strength was normalized to body mass, patients in the overnutrition group had the highest prevalence of weakness. Using NHANES reference data, maximum grip strength and NGS cutoffs were identified that could significantly distinguish the nutrition groups. Comprehensive nutritional assessments and grip strength measurements are feasible, non-invasive, easy to perform, and inform both under- and overnutrition in pediatric HCT survivors.
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Affiliation(s)
- Sandra Bouma
- Department of Pediatrics, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, USA
| | - Mark Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Erin Gatza
- Department of Pediatrics, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, USA
| | - Sung Won Choi
- Department of Pediatrics, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, USA
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Abdelhadi RA, Bouma S, Bairdain S, Wolff J, Legro A, Plogsted S, Guenter P, Resnick H, Slaughter-Acey JC, Corkins MR. Response to Salemi et al. JPEN J Parenter Enteral Nutr 2016; 40:911-2. [DOI: 10.1177/0148607116660314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abdelhadi RA, Bouma S, Bairdain S, Wolff J, Legro A, Plogsted S, Guenter P, Resnick H, Slaughter-Acey JC, Corkins MR. Characteristics of Hospitalized Children With a Diagnosis of Malnutrition. JPEN J Parenter Enteral Nutr 2016; 40:623-35. [DOI: 10.1177/0148607116633800] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/21/2016] [Indexed: 12/17/2022]
Affiliation(s)
| | - Sandra Bouma
- University of Michigan C.S. Mott Children’s Hospital, Ann Arbor, Michigan, USA
| | | | - Jodi Wolff
- Rainbow Babies and Children’s Hospital, Solon, Ohio, USA
| | - Amanda Legro
- Miller Children’s and Women’s Hospital, Long Beach, California, USA
| | | | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Helaine Resnick
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Jaime C. Slaughter-Acey
- College of Nursing & Health Professions School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Mark R. Corkins
- University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
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15
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Affiliation(s)
- Sandra Bouma
- University of Michigan Health System, Patient Food and Nutrition Services, Ann Arbor, Michigan
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16
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Jou C, Rhoads J, Bouma S, Ching S, Hoijer J, Schroeder-Poliak P, Zaun P, Smith S, Richards S, Caskey CT. Deletion detection in the dystrophin gene by multiplex gap ligase chain reaction and immunochromatographic strip technology. Hum Mutat 1995; 5:86-93. [PMID: 7728154 DOI: 10.1002/humu.1380050112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [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: 01/26/2023]
Abstract
The purpose of this study is to demonstrate the value of a multiplex amplification and readout system. The validation was done using as a model system the detection of deletions in nine possible dystrophin exons: 4, 8, 12, 17, 19, 44, 45, 48, and 51. The amplification system was gap ligase chain reaction, adapted to amplify selected regions of multiple exons simultaneously. The amplified products were read out with an immunochromatographic methodology, adapted from that used in the Abbott product line commercialized under the name Test Pack Plus. In each amplification, the beta-globin gene was incorporated and served as a procedural control. The complete process takes < 3 hr from DNA sample to result. The procedure is therefore rapid and simple, as well as being potentially very cost effective. The combination of these two technologies is shown to be a useful tool for the determination of deletions in the nine exons of the dystrophin gene. The results of a 100-patient sample study showed concordance with cDNA and PCR in current use. Equivalent performance at two sites was shown.
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Affiliation(s)
- C Jou
- Diagnostics Division, Abbott Laboratories, North Chicago, Illinois 60612, USA
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Fang P, Bouma S, Jou C, Gordon J, Beaudet AL. Simultaneous analysis of mutant and normal alleles for multiple cystic fibrosis mutations by the ligase chain reaction. Hum Mutat 1995; 6:144-51. [PMID: 7581398 DOI: 10.1002/humu.1380060207] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 01/26/2023]
Abstract
The ligase chain reaction (LCR) involves repetitive cycles of ligation of two adjacent pairs of oligonucleotides to form longer ligated products in a template-dependent manner. This study demonstrates the application of LCR for analysis of multiple small mutations. We adapted the technology for the simultaneous determination of the normal and mutant alleles in a competition format, as well as multiple mutations in a multiplex format. For these purposes, we used mutations causing cystic fibrosis, namely the delta F508, W1282X, and G551D mutations. Blunt ligation was compared to a strategy with a single base gap on one or both strands to be filled by thermostable polymerase prior to ligation. Blunt or gap strategies worked well for detection of the delta F508 mutation. Detection of the W1282X mutation worked well with a blunt strategy when high K+ concentration (180-220 mM) was used to reduce template-independent ligation. For reliable detection of the G551D mutation, we used mismatches in the oligonucleotides 2-5 bp away from the ligation site and hot start of the reaction to achieve allele specificity. Excellent discrimination of mutations was achieved using competitive LCR with six oligonucleotides (two common on one side of the mutation plus two wild type and two mutant on the opposite side with the mutation site at the end adjacent to the common oligonucleotides) and with multiplex-competitive LCR using 12 oligonucleotides to detect both alleles for two mutations in a single tube.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Fang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030-3498, USA
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Nieuwmeyer PA, Voorberg R, Bouma S. [Traumatic testicular dislocation]. Ned Tijdschr Geneeskd 1980; 124:1154-5. [PMID: 7402393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Groot G, Bouma S. [Choledochoduodenostomy for benign disorders of the biliary tract]. Ned Tijdschr Geneeskd 1976; 120:1241-3. [PMID: 934381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Bouma S, Doets HC, Mak G. [Femoral neck fractures in hemiplegic patients]. Ned Tijdschr Geneeskd 1976; 120:369-74. [PMID: 1256614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Snijder J, Jöbsis AC, Bouma S. [Several cases of an unusual lymphoreticular disease]. Ned Tijdschr Geneeskd 1972; 116:904-6. [PMID: 5026101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Bouma S. [Various aspects of thoracic injuries]. Tijdschr Ziekenverpl 1972; 25:490-6. [PMID: 4482776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Bouma S. [Typical and atypical radius fractures]. Ned Tijdschr Geneeskd 1970; 114:368-74. [PMID: 5414198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Bouma S. [A rare anomaly of the bile ducts]. Ned Tijdschr Geneeskd 1969; 113:198-200. [PMID: 5767923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Bouma S. [First aid in hemorrhages; the use of tourniquets]. Ned Tijdschr Geneeskd 1966; 110:1255-7. [PMID: 5947221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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