Browsing by Author "Blaauw, Renee"
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- ItemAllied health professional rural education: Stellenbosch University learners’ experiences(Health & Medical Publishing Group, 2016-10) Pillay, M.; Bester, J.; Blaauw, Renee; Harper, A.; Msindwana, A.; Muller, J.; Philips, L.ENGLISH SUMMARY : Background: Rural clinical training is not widely established or documented for allied health sciences (AHS) learners. This article focuses on the experiences of AHS learners from Stellenbosch University’s uKwanda Rural Clinical School. Objective: To explore learners’ practices with regard to rural clinical training in the AHS. Methods: A total of 22 documented reflections and seven educator or learner semi-structured focus group discussions, using critical conversations, were analysed with methods such as textual and thematic analysis and qualitative research software (ATLAS.ti, Germany). Results: The perception of rural clinical training was reported as an overwhelmingly positive experience. Practices positioned ‘rural’ as a catalyst for developing learners’ emerging identities as policy brokers, and as best when delivered by team participation. Professional education curricula were reported as dependant on: (i) context; (ii) educators; and (iii) how time was managed. Conclusion: Rural-based learning is a humanising experience for health science learners.
- ItemThe anthropometric, vitamin A and iron status of pre-school children in the Western and Northern Cape Provinces(Stellenbosch : Stellenbosch University, 1998-11) Blaauw, Renee; Labadarios, D.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Human Nutrition.ENGLISH ABSTRACT: Vitamin A deficiency (VAD) and anaemia are major nutritional disorders worldwide, including Africa . It has been estimated that ½ million children go blind annually due to vitamin A deficiency, whereas anaemia affects approximately a quarter of the world's population. Furthermore, protein energy malnutrition (PEM) is known to be responsible for 55 % of childhood deaths worldwide. n view of these relationships, the aims of this study were to establish the anthropometric, vitamin A and iron status of pre-school children in the Western Cape (as part of a national survey), as well as to identify major factors contributing to poor status.
- ItemAn anti-inflammatory approach to the dietary management of multiple sclerosis : a condensed review(Co-published by Medpharm Publications and Taylor & Francis, 2017) Labuschagne, I. L.; Blaauw, ReneeMultiple sclerosis (MS) is a chronic, inflammatory, neurodegenerative demyelinating disease of the central nervous system (CNS). Inflammation is increased by high-energy Western-style diets, typically high in salt, animal fat, red meat, sugar-sweetened drinks and fried food, and low in fibre, as well as lack of physical exercise. An anti-inflammatory dietary regimen, with or without administration of dietary supplements, supporting the general trend towards an amelioration of inflammatory status, should be considered. Understanding the role of gut microbiota in health and disease can lay the foundation to treat chronic diseases by modifying the composition of gut microbiota through lifestyle choices, including dietary habits and possibly probiotic supplementation. Evidence from experimental, epidemiologic and clinical studies supports the potential association between poor vitamin D status and the risk of developing MS, as well as an adverse disease course. Correcting vitamin D status seems plausible in patients with MS
- ItemApplication of evidence on probiotics, prebiotics and synbiotics by food industry : a descriptive study(London : Biomed Central, 2014-10) Mugambi, Mary N.; Young, Taryn; Blaauw, Renee; Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.ENGLISH ABSTRACT: This study assessed how the food industry applies the knowledge and evidence gained from synbiotics, probiotics or prebiotics research in infants, on the general paediatric population. This study also explored: what happens after the clinical trials using infant formula are completed, data is published or remains unpublished; the effectiveness and type of medium the formula manufacturers use to educate consumers on probiotic, prebiotic or synbiotic infant formula. Findings: This was a descriptive study (a survey) that used a structured questionnaire. All listed companies that manufacture and / or market food products with added probiotics, prebiotics or synbiotics for infants were identified and invited to participate. People responsible for research and development were invited to participate in the survey. A letter of invitation was sent to selected participants and if they expressed willingness to take part in the study, a questionnaire with a written consent form was sent. Descriptive statistics and associations between categorical variables were to be tested using a Chi-square test, a p < 0.05 was statistically significant. A total of 25 major infant formulas, baby food manufacturers were identified, invited to participate in the survey. No company was willing to participate in the survey for different reasons: failure to take any action 5 (20%), decision to participate indefinitely delayed 2 (8%), sensitivity of requested information 3 (12%), company does not conduct clinical trials 1 (4%), company declined without further information 4 (16%), erroneous contact information 6 (24%), refusal by receptionists to forward telephone calls to appropriate staff 3 (12%), language barrier 3 (12%), company no longer agrees to market research 1 (4%). Conclusion: Due to a poor response rate in this study, no conclusion could be drawn on how the food industry applies evidence gained through probiotics, prebiotics or synbiotics research on infants for the benefit of the general paediatric population. More information and greater transparency is needed from the infant formula manufacturers on how they apply the evidence gained from the research on probiotics, prebiotics and synbiotics on infants
- ItemAssessing the utilization of a child health monitoring tool(Health and Medical Publishing Group, 2017) Blaauw, Renee; Daniels, L.; Du Plessis, L. M.; Koen, N.; Koornhof, H. E.; Marais, M. L.; Van Niekerk, E.; Visser, J.Objective: The study assessed the implementation of growth monitoring and promotion, immunisation, vitamin A supplementation, and deworming sections of the Road-to-Health Booklet. Caregivers and health care workers knowledge, attitudes and practices were investigated as well as health care workers perceptions of barriers undermining implementation. Methods: A cross-sectional descriptive study was conducted on a proportional sample of randomly selected Primary Health Care facilities across six health districts (35%; n=143) in the Western Cape Province. Health care workers involved in the implementation of the Road-to-Health Booklet, children (0-36 months) and CGs were included. Information was obtained through scrutiny of the Road-to-Health Booklet, observation of consultations and structured questionnaires. Results: A total of 2442 children, 2481 caregivers and 270 health care workers were recruited. Weight (94.7%) measurements were performed routinely. Less than half (40.2%) of caregivers reported that their child’s growth was explained. Sixty-eight percent of health care workers correctly identified criteria for underweight, whereas only 55% and 39% could do so for stunting and wasting respectively. Road-to-Health Booklet sections were completed adequately for immunization (89.3%), vitamin A supplementation (94.6%) but not for deworming (48.8%). Most health care workers (94%) knew the correct regimes for vitamin A supplementation and deworming, but few caregivers knew when treatment was due for vitamin A supplementation (16.4%) and deworming (26.2%). Potential barriers identified related to inadequate training, staff shortages and limited time. Conclusion: Focussed effort and resources should be channelled towards health care workers training and monitoring regarding growth monitoring and promotion to optimize utilization of the Road-to-Health Booklet. Mobilisation of community health workers is needed to strengthen community awareness of preventative health interventions.
- ItemBody fat distribution as a risk factor for osteoporosis(Health & Medical Publishing Group, 1996) Blaauw, Renee; Albertse, E. C.; Hough, S.Objective. The aim of this study was to compare the body fat distribution of patients with osteoporosis (OP) with that of an appropriately matched non-OP control group. Design. Case control study. Setting. Department of Endocrinology and Metabolism, Tygerberg Hospital. Participants. A total of 56 patients with histologically proven idiopathic OP, of whom 39 were women (mean age 61 ± 11 years) and 17 men (49 ± 15 years), were compared with 125 age- and sex-matched non-OP (confirmed by dual energy X-ray absorptiometry) subjects, 98 women (60 ± 11 years) and 27 men (51 ± 16 years). Outcome measures. Anthropometric data, including weight, height, skinfold measurements, mid-upper arm, waist and hip circumferences, as well as elbow breadth. Results. The men and women with OP were significantly shorter (P = 0.04 and P = 0.03 respectively) and of lower body mass (P = 0.04 and P = 0.02 respectively) than the control subjects, although their mean body mass indices were comparable. The OP population had significantly lower skinfold, elbow breadth and arm circumference values, although the majority of subjects in both groups fell within the 15 - 85th percentiles. Despite their lower body mass, both the OP women (P = 0.009) and men (P = 0.002) had significantly higher waist/hip ratios than corresponding controls. Conclusion. Whatever the underlying pathogenesis, this new finding suggests that, should these results be confirmed by larger studies, OP can be added to the list of diseases associated with a waist fat distribution.
- ItemThe development of a single health-endorsement logo for South Africa(Cambridge University Press, 2018) Koen, Nelene; Wentzel-Viljoen, Edelweiss; Blaauw, ReneeObjective: To develop health-endorsement logos (HEL) for food products indicating healthy choices based on the South African nutrient profile model and to pilot test these logos with consumers. Design: Multistage mixed-methods design. Setting: Cape Town, South Africa. Subjects: Nine focus group discussions (FGD) were conducted with adult consumers to explore what types of HEL are preferred and why. Based on the findings, ten HEL were designed by a graphic design team. A modified Delphi technique, conducted with experts in the fields of nutrition and food science, was employed to eliminate lowest-scoring HEL and to improve the design of the remaining logos. Participants from the initial FGD participated in pilot testing the improved logos. Results: Participants from FGD (n 67) were positive about a single HEL, stating it would make food labelling less confusing as they did not understand the various HEL used. Participants indicated the logo should include wording related to ‘healthy choice’ or ‘better choice’ and pictures/symbols related to health and/or food. During two rounds of scoring and comments by experts (n 19), five logos were eliminated and the design of the remaining five improved. Three of five remaining logos received overall rankings of 3·08/5, 3·28/5 and 3·39/5, respectively, during FGD (n 36) in the pilot-testing phase. Conclusion: HEL were designed and consumer tested. Three designs were submitted to the national Department of Health to consider for implementation, after further testing, as a tool to assist in addressing the high incidence of non-communicable diseases in South Africa.
- ItemThe effects of anti-inflammatory agents as host-directed adjunct treatment of tuberculosis in humans : a systematic review and meta-analysis(BioMed Central, 2020-08-26) Hayford, Frank Ekow Atta; Dolman, Robin Claire; Blaauw, Renee; Nienaber, Arista; Smuts, Cornelius Mattheus; Malan, Linda; Ricci, CristianBackground: The potential role of adjunctive anti-inflammatory therapy to enhance tuberculosis (TB) treatment has recently received increasing interest. There is, therefore, a need to broadly examine current host-directed therapies (HDTs) that could accelerate treatment response and improve TB outcomes. Methods: This systematic review and meta-analysis included randomised controlled trials of vitamin D and other HDT agents in patients receiving antibiotic treatment for pulmonary TB. Sputum smear conversion rate at 4–8 weeks was the primary outcome. Secondary outcomes included blood indices associated with infectivity and inflammation, chest radiology and incidence of adverse events. Results: Fifty-five studies were screened for eligibility after the initial search, which yielded more than 1000 records. Of the 2540 participants in the 15 trials included in the meta-analysis, 1898 (74.7%) were male, and the age at entry ranged from 18 to 70 years. There was a 38% significantly (RR 1.38, 95% CI = 1.03–1.84) increased sputum smear negativity in patients administered with vitamin D in addition to standard TB treatment than those receiving only the TB treatment. Patients treated with other HDT anti-inflammatory agents in addition to TB treatment also had a 29% significantly increased sputum smear conversion rate (RR 1.29, 95% CI = 1.09–1.563). Lymphocyte to monocyte ratio was significantly higher in the vitamin D treatment groups compared to the controls (3.52 vs 2.70, 95% CI for difference 0.16–1.11, p = 0.009) and (adjusted mean difference 0.4, 95% CI 0.2 -- 0.6; p = 0.001); whilst tumour necrosis factor-alpha (TNF-α) showed a trend towards a reduction in prednisolone (p < 0.001) and pentoxifylline (p = 0.27) treatment groups. Vitamin D and N-acetylcysteine also accelerated radiographic resolution in treatment compared to placebo at 8 weeks. No differences were observed in the occurrence of adverse events among all HDT treatments. Conclusions: Vitamin D and other anti-inflammatory HDT medications used as adjunct TB treatment may be well tolerated and effective. They significantly improved sputum smear conversion rate and chest radiological appearance, and also exhibited an inflammation resolution effect.
- ItemEffects of rising food prices on household food security on femaleheaded households in Runnymede Village, Mopani District, South Africa(MedPharm Publications, 2016) Mkhawani, K.; Motadi, S. A.; Mabapa, N. S.; Mbhenyane, X. G.; Blaauw, ReneeBackground: Rising food prices can have a devastating effect on the health of poor households by making it more difficult for them to afford basic food baskets. Although South Africa is food secure as a nation, it does not mean that every household is able to access nutritionally adequate food. Objective: The objective of the study was to determine the effects of rising food prices on people’s perceptions and coping strategies regarding household food security. Setting: Sixty femaleheaded households were selected from 250 households in Runnymede Village in the Greater Tzaneen Local Municipality, Mopani District, Limpopo province, South Africa. Design: A descriptive and exploratory study was conducted using quantitative methods by means of an administered, structured questionnaire. The accessible population was femaleheaded households residing in Runnymede Village. Participants representing 60 femaleheaded households were purposively selected from the 250 households. Open and closed-ended questions were used to collect the data. Results: The majority (58%) of participants indicated that their eating habits had changed owing to rising food prices. Approximately 60% of the participants indicated that they bought food in bulk as a shortterm strategy to cope with rising food prices. Approximately 50% had a vegetable garden to alleviate food unavailability, and harvested for subsistence to meet non-food expenses. The majority (57%) of participants converted to buying cheaper brands, such as generic store brands. In addition, rising food prices made high quality food scarce for poorer households, forcing them to resort to cheaper or less nutritious foods. Conclusion: Rising food prices had a negative impact on poor, femaleheaded households in Runnymede Village.
- ItemEnteral formula : selecting the right formula for your patient(Medpharm Publications, 2017) Blaauw, Renee; Du Toit, Anna-LenaThe availability of various enteral formulae on the market assists in the individualized management of patients. It provides variety in terms of macronutrient content, fluid options and the addition or omission of certain components, e.g. fibre, electrolytes and immunonutrients. It is imperative that health care practitioners should be familiar with all products locally available and should have the ability to select the most appropriate products to meet the patient’s needs. We provide a brief summary of all enteral formulae in terms of unique features and recommendations for use. Practical application is discussed by means of two case studies.
- ItemExamining associations of HIV and iron status with nutritional and inflammatory status, anemia, and dietary intake in South African school children(MDPI, 2021) Goosen, Charlene; Baumgartner, Jeannine; Mikulic, Nadja; Barnabas, Shaun L.; Cotton, Mark F.; Zimmermann, Michael B.; Blaauw, ReneeThe etiology of multifactorial morbidities such as undernutrition and anemia in children living with the human immunodeficiency virus (HIV) (HIV+) on antiretroviral therapy (ART) is poorly understood. Our objective was to examine associations of HIV and iron status with nutritional and inflammatory status, anemia, and dietary intake in school-aged South African children. Using a two-way factorial case-control design, we compared four groups of 8 to 13-year-old South African schoolchildren: (1) HIV+ and low iron stores (inflammation-unadjusted serum ferritin ≤ 40 µg/L), n = 43; (2) HIV+ and iron sufficient non-anemic (inflammation-unadjusted serum ferritin > 40 µg/L, hemoglobin ≥ 115 g/L), n = 41; (3) children without HIV (HIV-ve) and low iron stores, n = 45; and (4) HIV-ve and iron sufficient non-anemic, n = 45. We assessed height, weight, plasma ferritin (PF), soluble transferrin receptor (sTfR), plasma retinol-binding protein, plasma zinc, C-reactive protein (CRP), α-1-acid glycoprotein (AGP), hemoglobin, mean corpuscular volume, and selected nutrient intakes. Both HIV and low iron stores were associated with lower height-for-age Z-scores (HAZ, p < 0.001 and p = 0.02, respectively), while both HIV and sufficient iron stores were associated with significantly higher CRP and AGP concentrations. HIV+ children with low iron stores had significantly lower HAZ, significantly higher sTfR concentrations, and significantly higher prevalence of subclinical inflammation (CRP 0.05 to 4.99 mg/L) (54%) than both HIV-ve groups. HIV was associated with 2.5-fold higher odds of iron deficient erythropoiesis (sTfR > 8.3 mg/L) (95% CI: 1.03–5.8, p = 0.04), 2.7-fold higher odds of subclinical inflammation (95% CI: 1.4–5.3, p = 0.004), and 12-fold higher odds of macrocytosis (95% CI: 6–27, p < 0.001). Compared to HIV-ve counterparts, HIV+ children reported significantly lower daily intake of animal protein, muscle protein, heme iron, calcium, riboflavin, and vitamin B12, and significantly higher proportions of HIV+ children did not meet vitamin A and fiber requirements. Compared to iron sufficient non-anemic counterparts, children with low iron stores reported significantly higher daily intake of plant protein, lower daily intake of vitamin A, and lower proportions of inadequate fiber intake. Along with best treatment practices for HIV, optimizing dietary intake in HIV+ children could improve nutritional status and anemia in this vulnerable population.
- ItemFood and nutrition labelling : the past, present and the way forward(MedPharm Publications, 2016) Koen, N.; Blaauw, Renee; Wentzel-Viljoen, E.Current global mortality from noncommunicable diseases (NCDs) remains unacceptably high and is increasing. A major reduction in the burden of NCDs should come from population-wide interventions, including the promotion of a healthy diet through the provision of adequate nutrition information on food labels. However, in order for this type of intervention to be successful, it is important to have a better understanding of the consumer. This review focuses on the need for food and nutrition labelling (the section of information on a food label that specifically declares nutrient content) within the context of NCDs, as well as consumer nutrition label use, and understanding and the impact of nutrition labelling on purchasing behaviour. It provides a summary of the latest global nutrition labelling trends, the current situation in South Africa and the way forward. Consumer knowledge, use and understanding of nutrition labelling has been investigated extensively in the international literature. However, the majority of these investigations were conducted in developed countries. Therefore, additional research on the impact of nutrition labelling in developing countries is necessary, and should be a priority. There have been many developments in South Africa in terms of food and nutrition labelling in the last decade. Although the food industry, health professionals and consumers face many changes, challenges and opportunities with regard to food, and specifically to nutrition labelling, this is also the ideal time to promote the use and understanding of nutrition information on labels by health professionals to consumers.
- ItemFood avoidance in irritable bowel syndrome leads to a nutrition-deficient diet(MedPharm Publications, 2014-08) Stevenson, Cheryl; Blaauw, Renee; Fredericks, Ernst; Visser, Janicke; Roux, SaartjieObjective: The objective was to assess the dietary intake of subjects with irritable bowel syndrome (IBS) and to compare it to that of international recommendations. The hypothesising assumption of this study was that a situation in which subjects insist that diet or trigger foods play a part in symptom generation may lead to an unbalanced dietary intake. Design: This was a descriptive observational study, with an analytical component. Setting: A private, secondary care-level clinic in South Africa. Subjects: The study population comprised 122 participants. Each subject completed an estimated, three-day dietary record. The data were analysed using a computerised food analysis programme. The fructose intake was analysed semi-quantitatively. IBS subjects’ protein and carbohydrate intake were significantly higher than the recommended dietary allowance for protein and carbohydrate (p-values < 0.000 and < 0.000, respectively). Outcome measures: The identification of dietary risk factors that affect IBS. Results: The IBS subjects’ daily total dietary fibre (15.13 g ± 13.11) was significantly lower (p-value < 0.000) than the dietary reference intake (DRI) target intake of 24.76 g/day, and the intake of micronutrients, calcium, iron and folate) was significantly less than the DRI. There was no significant difference in macronutrient intake between the diarrhoea-predominant IBS (D-IBS), constipation-predominant IBS (C-IBS) and the control groups. The total number of fructose serves per day was not statistically significant between the three groups (C-IBS 2.68 ± 1.68, D-IBS 2.15 ± 1.86, and controls 3.17 ± 2.39, p-value = 0.157). Conclusion: The IBS subjects in this study consumed diets that were deficient in key micronutrients and total fibre when judged against the recommended DRIs. Dietary adjustments may have been tailored by subjects to minimise symptom development and this led to nutritionally deficient diets.
- ItemHospital malnutrition in children : what are the challenges?(MedPharm Publications, 2018) Blaauw, ReneeNo abstract available
- ItemImplementation of the Road-to-Health-Booklet health promotion messages at primary health care facilities, Western Cape Province, South Africa(Health and Medical Publishing Group, 2017) Du Plessis, L. M.; Blaauw, Renee; Koornhof, H. E.; Marais, M. L.Background: Age-specific health promotion messages appear in the Road-to-Health-Booklet, an assessment and monitoring tool for child health in South Africa. Healthcare workers should communicate health promotion messages to caregivers at each clinic visit. Objective: This investigation, part of a larger Road-to-Health-Booklet survey, assessed the implementation of health promotion messages and identified barriers to its successful implementation. Methods: A cross-sectional descriptive study with analytical components was conducted in the Western Cape Province. Knowledge and practices of caregivers and healthcare workers were assessed at 143 randomly selected primary health care facilities. Information was obtained through questionnaires; direct observation of consultations and recording of health promotion material in facilities. Results: In total, 2442 children (0-36 months; mean age 6.26 ± 6.24 months.); 2481 caregivers and 270 healthcare workers were included. Caregivers' educational level varied, with only 24.3% completing Grade 12. Healthcare workers had a median of five years (0.5 - 37.0 years) work experience in primary health care. All healthcare workers indicated that health promotion messages are important, however, messages were only conveyed in 51% of consultations observed. If communicated, health promotion messages were age-appropriate in 97% of cases. Barriers to the implementation of health promotion messages hinged on time and staff constraints, workload and language barriers. Various forms of health promotion material were available in facilities. Conclusions: Sub-optimal implementation of the health promotion messages in the Road-to-Health-Booklet are apparent despite healthcare workers realising the importance of health promotion. Barriers to optimal implementation must be urgently addressed by the National Department of Health and healthcare workers in partnership with caregivers and supported by society to promote child health and care.
- ItemNutritional composition of South African eggs(Health & Medical Publishing Group, 1994) Herselman, M. G.; Blaauw, Renee; Labadarios, D.; Langenhoven, M. L.; Kruger, M.We congratulate Van Niekerk and Van Heerden on their excellent study on the nutritional composition of South African eggs,' in which they show that the cholesterol content of South African eggs is 23,5% lower than the values listed in the NRlND Food Composition Tables. The anicle raises a number of imponant issues that should be addressed.
- ItemObesity and other nutrition related abnormalities in pre-dialysis chronic kidney disease (CKD) participants(MDPI, 2020) Ebrahim, Zarina; Moosa, M. Rafique; Blaauw, ReneeChronic kidney disease (CKD) is increasing in sub-Saharan Africa. Undernutrition has been prevalent amongst end stage CKD patients, with limited data on the prevalence of obesity. The aim of this study was to assess the nutritional status of CKD patients using various methods sensitive to over and under-nutrition. Stage 3 to 5 CKD patients (glomerular filtration rate (GFR) < 60 mL/min/1.73 m2) attending a pre-dialysis clinic in Cape Town, were enrolled. Exclusion criteria included infectious and autoimmune conditions. Sociodemographic, clinical and biochemical data were collected, and anthropometric measurements were performed. Dietary intake was measured with a quantified food frequency questionnaire (FFQ). Statistical Package for the Social Sciences (SPSS) version 26 was used for statistical analysis. Seventy participants, with mean age of 41.8 ± 11.8 years, 52.9% females and 47.1% males were enrolled. Participants enrolled mainly had stage 5 kidney failure. Thirty percent were overweight (21) and 25 (36%) were obese, 22 (60%) of females were overweight and obese, while 13 (39.4%) of males were predominantly normal weight. Abdominal obesity was found in 42 (60%) of participants, mainly in females. Undernutrition prevalence was low at 3%. Dietary assessment showed a high sugar and protein intake. There was a high prevalence of overweight, obesity and abdominal obesity in CKD stage 35 patients, with unhealthy dietary intake and other nutritional abnormalities.
- ItemOpinions of South African dietitians on fistuloclysis as a treatment option for intestinal failure patients(MedPharm Publications, 2018) Du Toit, Anna-Lena; Boutall, Adam B. T.; Blaauw, ReneeIntroduction: Intestinal failure is the consequence of diverse aetiologies and pathophysiological causes. Fistuloclysis is an effective means of nutritional support to selected intestinal failure patients. This study aimed to investigate the management of adult intestinal failure patients in hospitals in South Africa, determining how practical and acceptable fistuloclysis is. Methods: The current management of type 2 and type 3 intestinal failure patients in South African hospitals was investigated by means of occupation-specific questionnaires, evaluating perceptions and opinions among dietitians. Results: Twenty-seven dietitians indicated willingness to participate in the survey, the majority (67%) having been involved with patient management in this field for one to five years. All indicated correctly that high fistula outputs would be defined as intestinal failure. Only 47% gave the correct definition of fistuloclysis, while 28% were currently utilising it as a means of nutrition support. All respondents agreed that unsuccessful implementation of fistuloclysis was due to training shortfalls and resistance from clinicians and nursing staff. Conclusion: There is a positive perception and awareness of fistuloclysis; however, numerous stumbling blocks hamper the wider use of this novel treatment.
- ItemPancreas cancer with Whipple’s operation(MedPharm Publications, 2015) Blaauw, ReneeThe following case study was discussed at the SASPEN Workshop held during the Nutrition Congress 2014. It is a reflection of the general opinion of the audience, followed by a rationale of the latest literature on the topic. Herewith follows a summarised discussion of the case.
- ItemPlasma glutamine levels in relation to intensive care unit patient outcome(MDPI, 2020) Blaauw, Renee; Nel, Daan G.; Schleicher, Gunter K.Low and high plasma glutamine levels are associated with increased mortality. This study aimed to measure glutamine levels in critically ill patients admitted to the intensive care unit (ICU), correlate the glutamine values with clinical outcomes, and identify proxy indicators of abnormal glutamine levels. Patients were enrolled from three ICUs in South Africa, provided they met the inclusion criteria. Clinical and biochemical data were collected. Plasma glutamine was categorized as low (<420 µmol/L), normal (420–700 µmol/L), or high (>700 µmol/L). Three hundred and thirty patients (median age 46.8 years, 56.4% male) were enrolled (median APACHE II score) 18.0 and SOFA) score 7.0). On admission, 58.5% had low (median 299.5 µmol/L) and 14.2% high (median 898.9 µmol/L) plasma glutamine levels. Patients with a diagnosis of polytrauma and sepsis on ICU admission presented with the lowest, and those with liver failure had the highest glutamine levels. Admission low plasma glutamine was associated with higher APACHE II scores (p = 0.003), SOFA scores (p = 0.003), C-reactive protein (CRP) values (p < 0.001), serum urea (p = 0.008), and serum creatinine (p = 0.023) and lower serum albumin (p < 0.001). Low plasma glutamine was also associated with requiring mechanical ventilation and receiving nutritional support. However, it was not significantly associated with length of stay or mortality. ROC curve analysis revealed a CRP threshold value of 87.9 mg/L to be indicative of low plasma glutamine levels (area under the curve (AUC) 0.7, p < 0.001). Fifty-nine percent of ICU patients had low plasma glutamine on admission, with significant differences found between diagnostic groupings. Markers of infection and disease severity were significant indicators of low plasma glutamine.