Comparison of two methods to assess malnutrition in community-dwelling people with Parkinson's disease

Nutritional status in people with Parkinson’s disease (PD) has previously been assessed in a number of ways including BMI, % weight loss and the Mini-Nutritional Assessment(MNA). The symptoms of the disease and the side effects of medication used to manage them result in a number of nutrition impact symptoms that can negatively influence intake. These include chewing and swallowing difficulties, lack of appetite, nausea, and taste and smell changes, among others. Community-dwelling people with PD, aged >18 years, were recruited (n=97, 61 M, 36 F). The Patient-Generated Subjective Global Assessment(PG-SGA) and (MNA) were used to assess nutritional status. Weight, height, mid-arm circumference(MAC) and calf circumference were measured. Based on SGA, 16(16.5%) were moderately malnourished (SGA B) while none were severely malnourished (SGA C). The MNA identified 2(2.0%) as malnourished and 22(22.7%) as at risk of malnutrition. Mean MNA scores were different between the three groups,F(2,37)=7.30,p<.05 but not different between SGA B (21.0(2.9)) and MNA at risk (21.8(1.4)) participants. MAC and calf circumference were also different between the three groups,F(2,37)=5.51,p<.05 and F(2,37)=15.33,p<.05 but not between the SGA B (26.2(4.2), 33.3(2.8)) and MNA at risk (28.4(5.6), 36.4(4.7)) participants. The MNA results are similar to other PD studies using MNA where prevalence of malnutrition was between 0-2% with 20-33% at risk of malnutrition. In this population, the PG-SGA may be more sensitive to assessing malnutrition where nutrition impact symptoms influence intake. With society’s increasing body size, it might also be more appropriate as it does not rely on MAC and calf circumference measures.

A novel DRD2 single-nucleotide polymorphism associated with schizophrenia predicts age of onset : HapMap tag-single-nucleotide polymorphism analysis

Background: Dopamine D2 receptor (DRD2) is thought to be critical in regulating the dopaminergic pathway in the brain which is known to be important in the aetiology of schizophrenia. It is therefore not surprising that most antipsychotic medication acts on the Dopamine D2 receptor. DRD2 is widely expressed in brain, levels are reduced in brains of schizophrenia patients and DRD2 polymorphisms have been associated with reduced brain expression. We have previously identified a genetic variant in DRD2, rs6277 to be strongly implicated in schizophrenia susceptibility. Methods: To identity new associations in the DRD2 gene with disease status and clinical severity, we genotyped seven single nucleotide polymorphisms (SNPs) in DRD2 using a multiplex mass spectrometry method. SNPs were chosen using a haplotype block-based gene-tagging approach so the entire DRD2 gene was represented. Results: One polymorphism rs2734839 was found to be significantly associated with schizophrenia as well as late onset age. Individuals carrying the genetic variation were more than twice as likely to have schizophrenia compared to controls. Conclusions: Our results suggest that DRD2 genetic variation is a good indicator for schizophrenia risk and may also be used as a predictor age of onset.

Managing intravenous medications in the non-hospital setting: An ethnographic investigation

Little published information exists about the issues involved in conducting complex intravenous medication therapy in patients' homes. An ethnographic study of a local hospital-in-the-home program in the Australian Capital Territory explored this phenomenon to identify those factors that had an impact on the use of medicine in the home environment. This article focuses on one of the three themes identified in the study-Clinical Practice. Within this theme, topics related to the organization and management of intravenous medications, geography and diversity of patient caseload, and communication in the practice setting are discussed. These findings have important implications for policy development and establishment of a research agenda for hospital-in-the-home services.

Lessons on sin and forgiveness : a crisis in the Roman Catholic Church

One of the greatest challenges facing the Roman Catholic Church (the Church) across the world continues to be found in addressing complaints of child sexual abuse (csa) by clergy. The list of Catholic clergy in Australia who have been criminally processed for sexual offences against children is disturbingly long. As disturbing as this list is, more disturbing are the accounts of clergy who have not been criminally prosecuted, but protected within the cloister of the Church. It is increasingly recognised that the significant difficulty with child sexual abuse in Catholic Churches, in particular, has not been the presence of perpetrators but the response of Church leadership to allegations of csa by clergy. Those who have faced criminal charges have often done so due to the resilience of victim/survivors and not because of the support of Church structures or culture. The Church has been slow to come to terms with the realities of the perpetration of csa by its clergy and even slower to recognise the need to prioritise victims in any effective, just response. The church has been slowest of all recognising that there are significant cultural and discursive challenges to confront in addressing the management of csa by clergy. There is, however, progressive recognition of the role that discursive constructs of forgiveness have played in perpetuating the crises and ultimately in perpetuating abuse. The institutional praxis of forgiveness can be demonstrated not only in the Church, but in lessons learned from use of forgiveness as an institutional response to mass violations of human rights. This paper explores the juncture between criminality, church culture and forgiveness in responding to csa by clergy.

Life impact of ankle fractures : qualitative analysis of patient and clinician experiences

Background: Ankle fractures are one of the more commonly occurring forms of trauma managed by orthopaedic teams worldwide. The impacts of these injuries are not restricted to pain and disability caused at the time of the incident, but may also result in long term physical, psychological, and social consequences. There are currently no ankle fracture specific patient-reported outcome measures with a robust content foundation. This investigation aimed to develop a thematic conceptual framework of life impacts following ankle fracture from the experiences of people who have suffered ankle fractures as well as the health professionals who treat them. Methods: A qualitative investigation was undertaken using in-depth semi-structured interviews with people (n=12) who had previously sustained an ankle fracture (patients) and health professionals (n=6) that treat people with ankle fractures. Interviews were audio-recorded and transcribed. Each phrase was individually coded and grouped in categories and aligned under emerging themes by two independent researchers. Results: Saturation occurred after 10 in-depth patient interviews. Time since injury for patients ranged from 6 weeks to more than 2 years. Experience of health professionals ranged from 1 year to 16 years working with people with ankle fractures. Health professionals included an Orthopaedic surgeon (1), physiotherapists (3), a podiatrist (1) and an occupational therapist (1). The emerging framework derived from patient data included eight themes (Physical, Psychological, Daily Living, Social, Occupational and Domestic, Financial, Aesthetic and Medication Taking). Health professional responses did not reveal any additional themes, but tended to focus on physical and occupational themes. Conclusions: The nature of life impact following ankle fractures can extend beyond short term pain and discomfort into many areas of life. The findings from this research have provided an empirically derived framework from which a condition-specific patient-reported outcome measure can be developed.

Effects of type 2 diabetes behavioural telehealth interventions on glycaemic control and adherence : a systematic review

We reviewed the effect of behavioural telehealth interventions on glycaemic control and diabetes self-management in patients with type 2 diabetes. The databases CINAHL, Medline and psychINFO were searched in August 2012. Journal articles were selected that had been published in English with a randomized controlled trial design using a usual care comparison group, and in which the primary intervention component was delivered by telehealth. Relevant outcome measures were glycaemic control and one or more of the following diabetes self-care areas: diet, physical activity, blood glucose self-monitoring (BGSM) or medication adherence. Interventions were excluded if they were primarily based on telemonitoring. The search retrieved 1027 articles, from which 49 were selected based on their title and abstract. Fourteen articles (reporting 13 studies) met the eligibility criteria for inclusion. Four studies reported significant improvements in glycaemic control. Five of eight studies on dietary adherence reported significant treatment effects, as did five of eight on physical activity, four of nine on blood glucose self-monitoring, and three of eight on medication adherence. Overall, behavioural telehealth interventions show promise in improving the diabetes self-care and glycaemic control of people with type 2 diabetes.

Treatment of cannabis use among people with psychotic disorders : critical review of randomised controlled trials

There is growing and converging evidence that cannabis may be a major risk factor in people with psychotic disorders and prodromal psychotic symptoms. The lack of available pharmacological treatments for cannabis use indicates that psychological interventions should be a high priority, especially among people with psychotic disorders. However, there have been few randomised controlled trials (RCTs) of psychological interventions among this group. In the present study we critically overview RCTs of psychological and pharmacologic interventions among people with psychotic disorders, giving particular attention to those studies which report cannabis use outcomes. We then review data regarding treatment preferences among this group. RCTs of interventions within "real world" mental health systems among adults with severe mental disorders suggest that cannabis use is amenable to treatment in real world settings among people with psychotic disorders. RCTs of manual guided interventions among cannabis users indicate that while brief interventions are associated with reductions in cannabis use, longer interventions may be more effective. Additionally, RCTs reviewed suggest treatment with antipsychotic medication is not associated with a worsening of cannabis cravings or use and may be beneficial. The development of cannabinoid agonist medication may be an effective strategy for cannabis dependence and suitable for people with psychotic disorders. The development of cannabis use interventions for people with psychotic disorders should also consider patients' treatment preferences. Initial results indicate face-to-face interventions focussed on cannabis use may be preferred. Further research investigating the treatment preferences of people with psychotic disorders using cannabis is needed.

The effect of Tai Chi on health related quality of life in people with elevated blood glucose or diabetes : a randomized controlled trial

Purpose The aim was to assess the effects of a Tai Chi based program on health related quality of life (HR-QOL) in people with elevated blood glucose or diabetes who were not on medication for glucose control. Method 41 participants were randomly allocated to either a Tai Chi intervention group (N = 20) or a usual medical care control group (N = 21). The Tai Chi group involved 3 x 1.5 hour supervised and group-based training sessions per week for 12 weeks. Indicators of HR-QOL were assessed by self-report survey immediately prior to and after the intervention. Results There were significant improvements in favour of the Tai Chi group for the SF36 subscales of physical functioning (mean difference = 5.46, 95% CI = 1.35-9.57, P < 0.05), role physical (mean difference = 18.60, 95% CI = 2.16-35.05, P < 0.05), bodily pain (mean difference = 9.88, 95%CI = 2.06-17.69, P < 0.05) and vitality (mean difference = 9.96, 95% CI = 0.77-19.15, P < 0.05). Conclusions The findings show that this Tai Chi program improved indicators of HR-QOL including physical functioning, role physical, bodily pain and vitality in people with elevated blood glucose or diabetes who were not on diabetes medication.

Ian Weir Research Architect

Dr Ian Weir's practice is driven by a passion for the Fitzgerald Bioregion, a remote, bushfire-prone landscape on the south coats of Western Australia which is renowned internationally for its biodiversity. It is here that Dr Weir collaborates with individuals and organisations from the fields of ecology, botany, bushfire science, land surveying, landscape architecture and art practice, all of whom seek to expand understandings of this remarkable landscape. This diverse practice formation is constructed to address a significant problem beyond the scope of conventional modes of architectural practice: the reconciliation of biodiversity and bushfire with human habitation, through a multimodal approach using art practice cartography and architectural intervention. The chapter articulates Dr Weir's practice through a formation diagram and depicts key works of landscape representaion taken from "Enacted Cartography" and "Lightsite", two of Dr Weir's key research themes.

Enacted Cartography : Formations - 2012 Venice Architecture Biennale

RESEARCH BACKGROUND Enacted Cartography documents 10 years of creative research practice by Ian Weir Research Architect and was developed as standalone exhibition to support Dr Weir’s selection by the Australian Institute of Architects to represent innovative architectural practice via the Institute’s review entitled Formations: New Practices in Australian Architecture – which took the form of an exhibition and book presented in Venice, Italy for 13th International Architecture Exhibition (Venice Architecture Biennale). All works exhibited in Enacted Cartography are original works by Dr Weir and are generated either from or for the remote biodiverse landscapes of the Fitzgerald Bioregion on the south coast of Western Australia. RESEARCH CONTRIBUTION As a creative work in its own right, the Enacted Cartography exhibition makes the following contributions to knowledge: 1. Expands understandings of architectural practice by presenting a geographically-specific but multimodal form of architectural practice - wherein practitioners cross over discipline boundaries into art practice, landscape representation, website design, undergraduate university teaching and community advocacy. 2. Contributes to understandings of how such a diverse multimodal form of practice might be represented through both digital media and traditional print media in an exhibition format. 3. Expands understandings of how architectural practitioners might work within a particular place to develop a geographically-specific sense of identity, a ‘landscape of resistance’. RESEARCH SIGNIFICANCE Enacted Cartography was presented to an international audience during the 13th International Architecture Exhibition (Venice Architecture Biennale). The significance of Dr Weir’s research is evidence by his selected by the Australian Institute of Architects to represent innovation in architectural practice for the Biennale. Enacted Cartography addresses problems of national and international importance including: 1. The sustainable development of biodiverse remote landscapes; 2. The reconciliation of bushfire safety and biodiversity conservation; 3. The necessity for rethinking of architectural design methodologies to meet the complexity of landscape management and design; 4. It challenges orthodox forms of landscape representation (aerial photography, for example) which are demonstrably inadequate registrations of biophysical and cultural landscapes.

Nurse staffing levels and the incidence of mortality and morbidity in the adult intensive care unit : a literature review

BACKGROUND: Studies have shown that nurse staffing levels, among many other factors in the hospital setting, contribute to adverse patient outcomes. Concerns about patient safety and quality of care have resulted in numerous studies being conducted to examine the relationship between nurse staffing levels and the incidence of adverse patient events in both general wards and intensive care units. AIM: The aim of this paper is to review literature published in the previous 10 years which examines the relationship between nurse staffing levels and the incidence of mortality and morbidity in adult intensive care unit patients. METHODS: A literature search from 2002 to 2011 using the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Australian digital thesis databases was undertaken. The keywords used were: intensive care; critical care; staffing; nurse staffing; understaffing; nurse-patient ratios; adverse outcomes; mortality; ventilator-associated pneumonia; ventilator-acquired pneumonia; infection; length of stay; pressure ulcer/injury; unplanned extubation; medication error; readmission; myocardial infarction; and renal failure. A total of 19 articles were included in the review. Outcomes of interest are patient mortality and morbidity, particularly infection and pressure ulcers. RESULTS: Most of the studies were observational in nature with variables obtained retrospectively from large hospital databases. Nurse staffing measures and patient outcomes varied widely across the studies. While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies concluded that a trend exists between increased nurse staffing levels and decreased adverse events. CONCLUSION: While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies demonstrated a trend between increased nurse staffing levels and decreased adverse patient outcomes in the intensive care unit which is consistent with previous literature. While further more robust research methodologies need to be tested in order to more confidently demonstrate this association and decrease the influence of the many other confounders to patient outcomes; this would be difficult to achieve in this field of research.

Markers of disease severity are associated with malnutrition in Parkinson's disease

Objective In Parkinson's disease (PD), commonly reported risk factors for malnutrition in other populations commonly occur. Few studies have explored which of these factors are of particular importance in malnutrition in PD. The aim was to identify the determinants of nutritional status in people with Parkinson's disease (PWP). Methods Community-dwelling PWP (>18 years) were recruited (n = 125; 73M/52F; Mdn 70 years). Self-report assessments included Beck's Depression Inventory (BDI), Spielberger Trait Anxiety Inventory (STAI), Scales for Outcomes in Parkinson's disease – Autonomic (SCOPA-AUT), Modified Constipation Assessment Scale (MCAS) and Freezing of Gait Questionnaire (FOG-Q). Information about age, PD duration, medications, co-morbid conditions and living situation was obtained. Addenbrooke's Cognitive Examination (ACE-R), Unified Parkinson's Disease Rating Scale (UPDRS) II and UPDRS III were performed. Nutritional status was assessed using the Subjective Global Assessment (SGA) as part of the scored Patient-Generated Subjective Global Assessment (PG-SGA). Results Nineteen (15%) were malnourished (SGA-B). Median PG-SGA score was 3. More of the malnourished were elderly (84% vs. 71%) and had more severe disease (H&Y: 21% vs. 5%). UPDRS II and UPDRS III scores and levodopa equivalent daily dose (LEDD)/body weight(mg/kg) were significantly higher in the malnourished (Mdn 18 vs. 15; 20 vs. 15; 10.1 vs. 7.6 respectively). Regression analyses revealed older age at diagnosis, higher LEDD/body weight (mg/kg), greater UPDRS III score, lower STAI score and higher BDI score as significant predictors of malnutrition (SGA-B). Living alone and higher BDI and UPDRS III scores were significant predictors of a higher log-adjusted PG-SGA score. Conclusions In this sample of PWP, the rate of malnutrition was higher than that previously reported in the general community. Nutrition screening should occur regularly in those with more severe disease and depression. Community support should be provided to PWP living alone. Dopaminergic medication should be reviewed with body weight changes.

Ginger (Zingiber officinale) and chemotherapy-induced nausea and vomiting : a systematic literature review

Chemotherapy-induced nausea and vomiting (CINV) is a common side-effect of cytotoxic treatment. It continues to affect a significant proportion of patients despite the widespread use of anti-emetic medication. In folk-medicine, ginger (Zingiber officinale) has been used to prevent and treat nausea in many cultures for thousands of years. However, its use has not been validated in the chemotherapy context. To determine the potential use of ginger as a prophylactic or treatment of CINV, a systematic literature review was conducted. Reviewed studies comprised randomised controlled trials or cross-over trials that investigated the anti-CINV effect of ginger as the sole intervention independent variable in chemotherapy patients. Seven studies met the inclusion criteria. All studies were assessed on methodological quality and their limitations were identified. Studies were mixed in their support of ginger as an anti-CINV treatment in patients receiving chemotherapy, with three demonstrating a positive effect, two in favour but with caveats and two showing no effect on measures of CINV. Future studies are required to address the limitations identified before clinical use can be recommended.

Bargara Pasturage Reserve : Future Visions

Bargara Pasturage Reserve: Future Visions This exhibition showcases the work of Postgraduate Landscape Architecture and final year Undergraduate Civil and Environmental Engineering students in response to issues of sustainability in a coastal wetland known as the Bargara Pasturage Reserve; an exemplar of the many issues facing sensitive coastal places in Queensland today. The 312ha Pasturage Reserve at Bargara is the only biofilter between the pressures of Bargara’s urban and tourism expansion, surrounding sugarcane farming, and the Great Sandy Marine Park, including the largest concentration of nesting marine turtles on the eastern Australian mainland. This ephemeral wetland, while struggling to fulfil its coastal biofiltration function, is also in high demand for passive recreation, and the project partners’ priorities were to meet both of these challenges. The students were required to plan and design for the best balance possible amongst, but not limited to: wetland and coastal ecological health, enhancement of cultural heritage and values, sustainable urban development, and local economic health. To understand these challenges, QUT staff and students met with partners, visited and analysed the Pasturage Reserve, spent time in and around Bargara talking to locals and inviting dialogue with Indigenous representatives and the South Sea Islander community. We then went home to Brisbane to undertake theoretical and technical research, and then worked to produce 11 Strategic Plans, 2 Environmental Management Plans and 33 Detailed Designs. One group of students analysed the Bargara coastal landscape as an historical and ongoing series of conversations between ecological systems, cultural heritage, community and stakeholders. Another group identified the landscape as neither ‘urban,’ ‘rural,’ nor ‘natural,’ instead identifying it metaphorically as a series of layered thematic ‘fields’ such as water, conservation, reconciliation, and educational fields. These landscape analyses became the organising mechanisms for strategic planning. An outstanding Strategic Plan was produced by Zhang, Lemberg and Jensen, entitled Metanoia, which means to ‘make a change as the result of reflection on values’. Three implementation phases of “flow”, “flux”, and “flex” span twenty-five years, and present a vision a coastal and marine research and conservation hub, with a focus on coastal wetland function, turtle habitat and coral reef conservation. An Environmental Management Plan by Brand and Stickland focuses on protecting and improving wetland biodiversity and habitat quality, and increasing hydrological and water quality function; vital in a coastal area of such high conservation value. After the planning phase, students individually developed detailed design proposals responsive to their plans. From Metanoia, Zhang concentrated on wetland access and interpretation, proposing four focal places to form the nucleus of a wider pattern of connectivity, and to encourage community engagement with coastal environmental management and education. Jensen tackled the thorny issue of coastal urban development, proposing a sensitive staged eco-village model which maintains both ecological and recreational connectivity between the wetland and the marine environment. This project offered QUT’s partners many innovative options to inform their future planning. BSC, BMRG and Oceanwatch Australia are currently engaged in the investigation of on-ground opportunities drawing on these options.

Nurses’ role in caring for people with a comorbidity of mental illness and intellectual disability : A literature review

This article examines literature on the role of the nurse caring for people with a dual disability (DD) of intellectual disability and mental illness. A search of the literature between 2000 and 2010 resulted in a total of 21 articles that met the inclusion criteria. Seven key categories of the role of the nurse were identified: (i) advocacy/health promotion (including working with family); (ii) assessment/case management; (iii) behavioural interventions; (iv) communication; (v) leadership and the nurse’s role within the multidisciplinary team; (vi) functions regarding medication administration; and (vii) safety/risk management. There is a paucity of research about the role of nurses working with people with DD, although a number of opinion-based articles exist. This article identifies a need for the role of the nurse working in DD to be more clearly articulated and for the development of evidence to guide best practice.