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Biomedical subjects

T Coyne

Publications and source records attributed to T Coyne.

9 recordsLinked to original sources
PubMed1995

Nutrition intervention program of the Modification of Diet in Renal Disease Study: a self-management approach.

OBJECTIVE: To characterize the Modification of Diet in Renal Disease (MDRD) Study nutrition intervention program by determining the frequency of intervention strategies used by the dietitians and the usefulness of program components as rated by participants. DESIGN: Dietitians recorded which of 32 intervention strategies they used at each monthly visit. Participants rated the usefulness of 19 program components. SUBJECTS: 840 adults with renal insufficiency. INTERVENTION: Participants were assigned randomly to usual-, low-, or very-low-protein diet groups. Each eating pattern also specified a phosphorus intake goal. Each participant met monthly with a dietitian for an average of 26 months. STATISTICAL ANALYSES: Analyses of variance and chi 2 analyses. RESULTS: Dietitians used the following intervention strategies most often in all groups: providing feedback based on self-monitoring and/or food records, reviewing adherence or biochemistry data, providing low-protein foods, and reviewing graphs of adherence progress. In general, the dietitians used feedback, modeling, and support strategies more often, and knowledge and skills strategies less often, with participants who had to make the greatest reductions in protein intake and those with more advanced disease. In all groups, the dietitians' use of knowledge and skills, feedback, and modeling strategies decreased over time (P < .001), whereas use of support strategies was maintained. The type and frequency of intervention strategies used by dietitians and the usefulness ratings of participants did not vary by educational level of the participant. Both self-monitoring and dietitian support were rated as "very useful" by 88% of the participants. CONCLUSIONS: Three features were central to the MDRD Study nutrition intervention program: feedback, particularly from self-monitoring and from measures of adherence; modeling, particularly by providing low-protein food products; and dietitian support. We recommend the self-management approach.

Adult↗
PubMed1995

Factors associated with adherence to the dietary protein intervention in the Modification of Diet in Renal Disease Study.

OBJECTIVE: To determine the characteristics and behaviors associated with adherence to dietary protein interventions among participants with chronic renal disease in the Modification of Diet in Renal Disease (MDRD) Study. DESIGN: Participants were categorized as consistent adherers or nonadherers on the basis of urinary urea nitrogen excretion and dietary protein intake data from self-reports. Psychosocial and behavioral factors were compared between groups. SUBJECTS: Subgroups of consistently adherent and non-adherent participants in the MDRD Study. SETTING: 15 clinical centers in the United States. INTERVENTION: In the nutrition intervention program, participants were assigned randomly to a usual-, low-, or very-low-protein diet group. Each eating pattern also specified a phosphorus goal. STATISTICAL ANALYSIS: Analysis of variance. RESULT: Psychosocial factors significantly related to adherence included participant knowledge, attitude, support, satisfaction, and self-perception of success. Behavioral strategies including participant self-monitoring of protein intake and the provision of feedback by the dietitian were also significantly related to adherence. APPLICATION: Nutrition interventions for patients with renal disease should focus on psychosocial factors and behavioral approaches. Such approaches can be successfully incorporated into treatment programs and will assist the dietitian in promoting adherence to usual-, low-, and very-low-protein eating patterns.

Adult↗
PubMed1995

Dietary satisfaction correlated with adherence in the Modification of Diet in Renal Disease Study.

OBJECTIVE: To measure satisfaction with modified protein eating patterns and the relationship of satisfaction to adherence and sociodemographic factors in a clinical trial. DESIGN: Participants completed the Dietary Satisfaction Questionnaire at baseline, at 6-month follow-up visits, at annual visits, and at the final visit. Satisfaction with diet was rated on a visual analog scale from 1 (dislike extremely) to 5 (like very much). Adherence to protein goals was assessed using urine urea nitrogen excretion from monthly 24-hour urine samples. SUBJECTS: 840 adults with chronic renal disease. INTERVENTION: Individual participants, randomly assigned to a usual-protein, low-protein, or very-low-protein group, received monthly counseling from a dietitian for an average of 26 months. STATISTICS: Analyses of variance and two-sample t tests compared, among study/diet groups, satisfaction with diet, its relationship to adherence and sociodemographic characteristics, and changes in satisfaction over time. Paired t tests compared changes within diet groups from baseline to final visit. RESULTS: From the baseline visit to the final visit, satisfaction with the prescribed eating pattern increased slightly in the usual-protein group, declined slightly in the low-protein group, and declined significantly in the very-low-protein group. Participants in all of the eating pattern groups who were more satisfied at the final visit had mean protein intakes closer to their assigned protein goals. This relationship was significant in the low-protein group (P < .05). In men, satisfaction with diet declined significantly from baseline to the final follow-up visit in the very-low-protein group. APPLICATIONS: The Modification of Diet in Renal Disease Study Dietary Satisfaction Questionnaire may be useful in other research and clinical settings to assess and enhance dietary adherence.

Adult↗
PubMed1993

Recruitment experience in the full-scale phase of the Modification of Diet in Renal Disease Study.

The Modification of Diet in Renal Disease (MDRD) Study is a randomized, multicenter clinical trial testing the effects of three different levels of dietary protein and phosphorus intake and two levels of blood pressure control on the rate of loss of kidney function in persons with various chronic kidney diseases. During a 27-month recruitment period, 2507 persons who had objective evidence of impaired kidney function were screened at 15 centers. Eight hundred and forty men and women aged 18-70 with a glomerular filtration rate between 13 and 55 ml/min/1.73 m2 were randomized. Medical record review was the primary means of identifying study participants at the beginning of recruitment. Later, use of mass media was instrumental in alerting both the public and the medical community of the need for MDRD Study participants. Overall, the most important sources of randomized participants were referral by personal physician (45.4%) and relative/friend (5.6%), and self-referral after hearing about the trial from newspapers (23.9%) and television (5.2%). Review of medical records from defined patient populations was the source of 22.3% of the randomized study participants. A total of 9.4% of the randomized participants called a toll-free (800) telephone number before contacting the centers.

Adolescent↗
PubMed1992

A survey of interhospital transfer of head-injured patients with inadequately treated life-threatening extracranial injuries.

A 12 month prospective study was undertaken to determine the frequency of untreated life-threatening extracranial injuries in patients transferred to a major trauma centre because of head injury. Of the 43 patients transferred (15 with isolated head injury and 28 with multiple injuries), four (9%) had an untreated life-threatening extracranial injury, which caused death in two. All four patients with untreated extracranial injuries were transferred from hospitals with general surgical staff and facilities. In three of the patients (none with a major head injury), the extracranial injuries were recognized at the referring hospital, but were left untreated in the rush to transfer the patient to a neurosurgical facility. In the fourth patient, who had a severe head injury, recurrent hypotension from a ruptured spleen was mistakenly ascribed to a scalp wound. The series shows that the dangerous practice of hurriedly transferring patients to trauma centres because of actual or perceived head injuries, while leaving major extracranial injuries untreated, continues despite warnings in the literature and the efforts of the Royal Australasian College of Surgeons through the Early Management of Severe Trauma programme.

Adolescent↗
PubMed1980

Evaluation of preschool meals programmes on the nutritional health of Aboriginal children.

One hundred and sixteen three to five year old Aboriginal children were included in an evaluation of the effect of preschool meals programmes on their nutritional health. Sixty-one children attending preschools in five communities were examined at the beginning and end of the school year. Fifty-five control children in five matched communities had two examinations, 38 weeks apart. Height, weight and haemoglobin concentrations were determined on all children and serum levels of ascorbic acid, ferritin, iron, total protein, albumin, cholesterol and triglycerides were determined on a subsample. Aboriginal children in both groups had initial measurements and nutrient levels below acceptable levels. The 61 children who received preschool meals had consistently better growth than the control children. A negative correlation was found between gains in weight and height and serum levels of ferritin, haemoglobin and ascorbic acid, indicating that more rapidly growing children may have been rapidly utilizing nutrients for growth.

Ascorbic Acid↗