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K Whelan

Publications and source records attributed to K Whelan.

14 recordsLinked to original sources
PubMed2005

Clinical, microbiological, and immunological effects of fructo-oligosaccharide in patients with Crohn's disease.

BACKGROUND AND AIMS: The intestinal microbiota play a pivotal role in the inflammation associated with Crohn's disease through their interaction with the mucosal immune system. Some bifidobacteria species are immunoregulatory and induce increased dendritic cell interleukin 10 (IL-10) release in vitro. Fructo-oligosaccharides (FOS) increase faecal and mucosal bifidobacteria in healthy volunteers. The aim of this study was to assess the effect of FOS administration on disease activity, bifidobacteria concentrations, and mucosal dendritic cell function in patients with moderately active Crohn's disease. PATIENTS AND METHODS: Ten patients with active ileocolonic Crohn's disease received 15 g of FOS for three weeks. Disease activity was measured using the Harvey Bradshaw index. Faecal and mucosal bifidobacteria were quantified by fluorescence in situ hybridisation, and mucosal dendritic cell IL-10 and Toll-like receptor (TLR) expression were assessed by flow cytometry of dissociated rectal biopsies. RESULTS: FOS induced a significant reduction in the Harvey Bradshaw index from 9.8 (SD 3.1) to 6.9 (3.4) (p<0.01). There was a significant increase in faecal bifidobacteria concentration from 8.8 (0.9) log(10) to 9.4 (0.9) log(10) cells/g dry faeces (p<0.001). The percentage of IL-10 positive dendritic cells increased from 30 (12)% to 53 (10)% (p=0.06). Finally, the percentage of dendritic cells expressing TLR2 and TLR4 increased from 1.7 (1.7)% to 36.8 (15.9)% (p=0.08) and from 3.6 (3.6)% to 75.4 (3.4)% (p<0.001), respectively. CONCLUSIONS: FOS supplementation increases faecal bifidobacteria concentrations and modifies mucosal dendritic cell function. This novel therapeutic strategy appears to decrease Crohn's disease activity in a small open label trial and therefore warrants further investigation.

Adult↗
PubMed2005

Interprofessional education in undergraduate healthcare programmes: the reaction of student dietitians.

BACKGROUND: Interprofessional education (IPE) is a novel teaching and learning initiative where students of more than one health profession learn interactively together. However, despite its potential for improving interprofessional relationships, there is little information regarding the participation of student dietitians in IPE. The aim of this paper was to consider the reaction of student dietitians to an IPE course in order to stimulate debate between dietitians regarding the issues relating to IPE. METHODS: Student dietitians participated in an IPE course consisting of seven sessions on communication and ethics in health care together with students of medicine and nursing. Student dietitians completed an evaluation questionnaire following each session that surveyed their reaction to the session using both a Likert scale and free-text comments. RESULTS: Twenty-six student dietitians completed the IPE course. All sessions were rated positively for interest value (P < or = 0.14), learning experience (P < or = 0.036) and value for clinical practice (P < or = 0.05). The limited number of free-text comments indicated some positive experiences regarding interprofessional learning, teaching content and teaching strategy. CONCLUSIONS: This is one of very few evaluations to describe the reaction of student dietitians to IPE. Student dietitians had largely positive reactions to the IPE course. Further research is required to evaluate whether these positive reactions were a direct consequence of the inclusion of students from other health professions and whether these translate into positive effects on learning, behaviour and results. The opportunities for the dietetic profession posed by students' involvement in IPE are discussed.

Adult↗
PubMed2004

Assessment of fecal output in patients receiving enteral tube feeding: validation of a novel chart.

OBJECTIVE: To develop a practical, valid and reliable chart to assist in the accurate visual characterization of fecal output in patients receiving enteral tube feeding (ETF). DESIGN: A chart incorporating verbal and pictorial descriptors of fecal output was developed. Validity and reliability were assessed by a questionnaire survey of health professionals and a clinical study of patients commencing ETF. Content validity was assessed from the results of the questionnaire, construct validity by contrasting groups analysis, concurrent validity by comparison of the chart with actual fecal weight and inter-rater reliability by independent characterization of the same fecal sample by two nurses. SETTING: St George's Hospital, London, UK. SUBJECTS: In all, 35 health professionals completed a questionnaire with respect to the chart. The chart was then used to monitor fecal output in 36 patients commencing ETF for a total of 171 patient-days, during which time nurses used the chart to characterize 269 fecal samples, of which 59 were subsequently weighed. RESULTS: The results of the questionnaire suggested good content validity. The chart demonstrated statistically significant differences in fecal frequency, fecal consistency, fecal score and incidence of diarrhea for contrasting patient groups expected to have different fecal output (P < 0.05). The inter-rater reliability was almost perfect for fecal consistency (95% agreement, kappa = 0.91) and substantial for fecal weight (83%, kappa = 0.75). In all, 83% of fecal samples were assigned to the correct weight category (kappa = 0.75). CONCLUSION: The chart has good content, construct and concurrent validity and inter-rater reliability, and is suitable for both research and clinical use. SPONSORSHIP: This research was jointly supported by King's College London and Nestlé, UK.

Diarrhea↗
PubMed2003

Defining and reporting diarrhoea during enteral tube feeding: do health professionals agree?

INTRODUCTION: The criteria used to define diarrhoea during enteral tube feeding (ETF) and the interrater reliability of nursing staff reporting it in clinical practice has not been investigated. METHODS: A structured questionnaire was sent to a cohort of dietitians, specialist stroke nurses, intensive therapy unit (ITU) nurses and consultant gastroenterologists regarding their criteria for defining ETF diarrhoea. In a clinical study, nursing staff independently inspected faeces from patients receiving ETF and were asked whether they considered the patient to have diarrhoea. RESULTS: Thirty-five healthcare workers responded to the questionnaire. Faecal frequency, faecal consistency and faecal quantity were all considered important criteria in defining ETF diarrhoea. Faecal frequency was considered more important than consistency and quantity (P = 0.048), although not all professional groups agreed on the order of importance. In the clinical study, nursing staff agreed on the presence or absence of diarrhoea on 75% of occasions, with agreement being only fairly reliable (kappa = 0.48). CONCLUSION: Healthcare workers use a range of criteria to define ETF diarrhoea, but may not agree on the importance of each criteria. In order to prevent confusion between professional groups, healthcare workers should be encouraged to describe faecal characteristics rather than rely on the term 'diarrhoea'.

Diarrhea↗
PubMed2001

The role of probiotics and prebiotics in the management of diarrhoea associated with enteral tube feeding.

INTRODUCTION: Diarrhoea is a common and serious complication of enteral tube feeding, and has a range of aetiologies. Manipulation of the colonic microflora may reduce the incidence of enteral tube feeding diarrhoea via suppression of enteropathogens and production of short-chain fatty acids. Probiotics and prebiotics are commonly used during enteral tube feeding to manipulate the colonic microflora; however, their efficacy is as yet uncertain. METHODS: English-language studies investigating the pathogenesis of enteral tube feeding diarrhoea and the use of probiotics and prebiotics were identified by searching the electronic databases CINAHL, EMBASE and MEDLINE from 1980 to 2001. The bibliographies of articles obtained were searched manually. RESULTS: Only two prospective, randomized, double-blind, placebo-controlled trials have investigated the effect of a probiotic on enteral tube feeding diarrhoea; however, results are conflicting. No prospective, randomized, double-blind, placebo-controlled studies have specifically addressed the effect of a prebiotic on the incidence of enteral tube feeding diarrhoea. CONCLUSION: Theoretically, probiotics and prebiotics may be of benefit in prophylaxis against enteral tube feeding diarrhoea; however, there is currently insufficient evidence to support their routine use. Prospective, randomised, double-blind, placebo-controlled studies investigating their effect on diarrhoea are required. These observations are discussed with reference to the current literature.

Diarrhea↗
PubMed2001

Inadequate fluid intakes in dysphagic acute stroke.

BACKGROUND AND AIMS: To investigate the fluid intakes of patients with dysphagic acute stroke and to evaluate the effect of disability, the ward speciality and the type of fluid given on oral intake. METHODS: Patients were prospectively recruited and randomly assigned to receive powder-thickened fluids or ready prepared pre-thickened fluids. Parenteral, enteral and oral fluid intakes, urine output, clinical sequelae and the frequency of requests for biochemical measures of hydration were recorded for a maximum of fourteen days. RESULTS: 24 patients with dysphagic acute stroke requiring thickened fluids were recruited from a large teaching hospital. Mean thickened fluid intake was 455 ml/d (SEM+/-70) resulting in the use of an extra 742 ml/d (+/-132) of supplementary fluids. This did not result in an adequate total intake due to insufficient volumes being given for too short a period. Patients not on specialist stroke units who received pre-thickened fluids drank almost 100% more than those on powder-thickened fluids (P=0.04). CONCLUSIONS: Fluid intakes in this patient group are insufficient to achieve requirements. Hospital staff must ensure adequate fluid intakes in patients at risk of dehydration, which should include both an adequate prescription and provision of supplementary fluids. Pre-thickened drinks improve oral fluid intake in patients with dysphagic acute stroke on non-specialist wards.

Acute Disease↗
PubMed2000

Identifying amino acid residues in medium resolution critical point graphs using instance based query generation.

Instance Based Query Generation is defined and applied to the problem of recognising amino acid residues in medium resolution critical point graphs. The technique is an amalgamation of Relational Instance Based Learning and Frequent Query Discovery in First Order Logic. Instances are automatically constructed from a deductive database and first order association rules are derived from the instances. The initial investigations presented here indicate that the technique is able to discriminate some of the larger amino acid types as well as discriminating the protein from background solvent. Identification of the smaller amino acids remains difficult and requires further work.

Amino Acids↗
PubMed1990

Parallel increases in striatal glutamic acid decarboxylase activity and mRNA levels in rats with lesions of the nigrostriatal pathway.

Adult male rats were lesioned with 6-hydroxydopamine in order to destroy the nigrostriatal dopaminergic projections. In rats with such a lesion, we found a parallel increase in glutamic acid decarboxylase (GAD) activity and GAD mRNA in the striatum ipsilateral to the lesion at 4 weeks and 4 months after the lesion. These observations support the proposal that nigral dopaminergic neurons exert a tonic inhibitory control over the striatal GABAergic neurons. Our observations also suggest that the dopaminergic neurons can inhibit gene expression in striatal GABAergic neurons and that the enhanced striatal GAD activity following lesions of the dopaminergic projections is due to 'de novo' synthesis of the enzyme.

Animals↗
PubMed1989

CML-T1: a cell line derived from T-lymphocyte acute phase of chronic myelogenous leukemia.

Most data suggest that malignant transformation in chronic myelogenous leukemia (CML) occurs in hematopoietic stem cell that is the progenitor of myelopoiesis and of B but not T lymphopoiesis. We established a T-lymphoid cell line (CML-T1) from a person with Ph-chromosome-negative CML in acute phase. Evidence of its T-lymphocyte origin includes the pattern cytochemical reactivity, reactivity with anti-T-cell monoclonal antibodies (MoAbs), and rearrangement of the beta-T-cell receptor (TCRB) gene. CML-T1 cells have features of type IV thymocytes. Cytogenetic analyses indicate a 47,XX, del(11), t(6;7)(q23;q24), +mar karyotype. CML-T1 cells exhibit molecular changes typical of CML, including translocation of the ABL protooncogene from chromosome 9 to 22, rearrangement of the BCR gene, and transcription of a chimeric BCR-ABL messenger RNA (mRNA). The ABL insertion on chromosome 22 appears interstitial, similar to other cases of Ph-chromosome-negative CML. These data clearly indicate that T cells can be involved in acute-phase CML. CML-T1 should be useful in studying this process as well as that underlying Ph-chromosome-negative CML.

Adult↗