Differences in Occupational Burnout Among Primary Care Professionals.

Background: Occupational burnout is a major concern for personal well-being and patient care. We examined burnout among primary care providers (PCPs), medical residents, behavioral health providers (BHPs), nurses, and other clinical and nonclinical primary care team members.

Methods: This was a cross-sectional study, nested within a larger randomized trial.

Persistent Hypertension in Children and Adolescents: A 6-Year Cohort Study.

Objectives: To determine the natural history of pediatric hypertension.

Methods: We conducted a 72-month retrospective cohort study among 165 primary care sites. Blood pressure measurements from two consecutive 36 month periods were compared.

Usefulness of Assessment of Stool Form by the Modified Bristol Stool Form Scale in Primary Care Pediatrics.

Purpose: Rome criteria are considered the gold standard for diagnosing functional constipation. The modified Bristol stool form scale (m-BSFS) was validated to measure stool form in children. However, neither the potential use of the m-BSFS as a tool to facilitate the diagnosis of potential constipation, nor the agreement between m-BSFS and stool consistency by Rome has been studied.

Comparison of the Availability and Cost of Foods Compatible With a Renal Diet Versus an Unrestricted Diet Using the Nutrition Environment Measures Survey.

Objective: Hemodialysis patients' ability to access food that is both compatible with a renal diet and affordable is affected by the local food environment. Comparisons of the availability and cost of food items suitable for the renal diet versus a typical unrestricted diet were completed using the standard Nutrition Environment Measures Survey and a renal diet-modified Nutrition Environment Measures Survey.

Design: Cross-sectional study.

Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study.

Background And Objectives: Pediatric hypertension predisposes children to adult hypertension and early markers of cardiovascular disease. No large-scale studies have examined diagnosis and initial medication management of pediatric hypertension and prehypertension. The objective of this study was to evaluate diagnosis and initial medication management of pediatric hypertension and prehypertension in primary care.

If we build it, we will come: a model for community-led change to transform neighborhood conditions to support healthy eating and active living.

Neighborhoods affect health. In 3 adjoining inner-city Cleveland, Ohio, neighborhoods, residents have an average life expectancy 15 years less than that of a nearby suburb. To address this disparity, a local health funder created the 2010 to 2013 Francis H.

Using a web-based nutrition algorithm in hemodialysis patients.

Objectives: The purpose of this study was to test the ability of a newly developed nutrition algorithm on (1) clinical utility and (2) ability to capture patient outcomes.

Research Design: This was a prospective observational study, using a practice based research network structure, involving renal dietitians and hemodialysis [HD] patients.

Setting: This study took place in HD outpatient units in five different countries.

The prevalence of phosphorus-containing food additives in top-selling foods in grocery stores.

Objective: The objective of this study was to determine the prevalence of phosphorus-containing food additives in best-selling processed grocery products and to compare the phosphorus content of a subset of top-selling foods with and without phosphorus additives.

Design: The labels of 2394 best-selling branded grocery products in northeast Ohio were reviewed for phosphorus additives. The top 5 best-selling products containing phosphorus additives from each food category were matched with similar products without phosphorus additives and analyzed for phosphorus content.

The adequacy of phosphorus binder prescriptions among American hemodialysis patients.

Because hemodialysis treatment has a limited ability to remove phosphorus, dialysis patients must restrict dietary phosphorus intake and use phosphorus binding medication. Among patients with restricted dietary phosphorus intake (1000 mg/d), phosphorus binders must bind about 250 mg of excess phosphorus per day and among patients with more typical phosphorus intake (1500 mg/d), binders must bind about 750 mg/d. To determine the phosphorus binding capacity of binder prescriptions among American hemodialysis patients, we undertook a cross-sectional study of a random sample of in-center chronic hemodialysis patients.

Impact of navigators on completion of steps in the kidney transplant process: a randomized, controlled trial.

Background And Objectives: Many patients with ESRD, particularly minorities and women, face barriers in completing the steps required to obtain a transplant. These eight sequential steps are as follows: medical suitability, interest in transplant, referral to a transplant center, first visit to center, transplant workup, successful candidate, waiting list or identify living donor, and receive transplant. This study sought to determine the effect of navigators on completion of steps.

Effect of an iPod video intervention on consent to donate organs: a randomized trial.

Background: The gap between the supply of organs available for transplantation and demand is growing, especially among ethnic groups.

Objective: To evaluate the effect of a video designed to address concerns of ethnic groups about organ donation.

Design: Cluster randomized, controlled trial.

A preliminary report on the functioning and data collection capabilities of a web-based nutrition algorithm for patients with chronic kidney disease.

Objective: The purpose of this study was to test the functional and data collection capabilities of an online nutrition algorithm for patients with chronic kidney disease by comparing dietitian-selected nutrition diagnoses, etiologies, and interventions in hemodialysis (HD) patients with and without diabetes mellitus (DM).

Design: Data were collected using an online nutrition screening tool and algorithm for HD patients based on the American Dietetic Association's Nutrition Care Process.

Setting: Data were collected by dietitians in the United States, New Zealand, Australia, and Brazil.

Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial.

Context: High dietary phosphorus intake has deleterious consequences for renal patients and is possibly harmful for the general public as well. To prevent hyperphosphatemia, patients with end-stage renal disease limit their intake of foods that are naturally high in phosphorus. However, phosphorus-containing additives are increasingly being added to processed and fast foods.

Fast food, phosphorus-containing additives, and the renal diet.

Objective: Fast food is commonly consumed by hemodialysis patients, but many menu items are not compatible with renal diets because of their sodium, potassium, or phosphorus content. Moreover, the phosphorus content of fast foods is difficult for patients to estimate, because phosphorus-containing additives are commonly added to many fast foods. We sought to determine how many fast-food entrees and side dishes are compatible with renal diets.

Public health approach to addressing hyperphosphatemia among dialysis patients.

Elevated serum phosphorus levels are a major source of morbidity and mortality for the 350,000 Americans receiving chronic dialysis treatment. Despite the widespread application of medical and behavioral interventions, the prevalence of hyperphosphatemia remains exceedingly high. At first glance, a public health perspective may seem inappropriate for addressing a disorder of mineral metabolism among patients receiving a life-sustaining treatment.

Phosphorus-containing food additives and the accuracy of nutrient databases: implications for renal patients.

Objective: Phosphorus-containing additives are increasingly being added to food products. We sought to determine the potential impact of these additives. We focused on chicken products as an example.

Multicenter study of the validity and reliability of subjective global assessment in the hemodialysis population.

Objective: Subjective Global Assessment (SGA) is a nutrition assessment tool recommended by the 2000 NKF K/DOQI Nutrition Guidelines. However, the validity and reliability of this tool have not been established in hemodialysis (HD) patients. The purpose of this observational study was to determine the reliability and validity of SGA in the HD population.

The prevalence and nutritional implications of fast food consumption among patients receiving hemodialysis.

Background: Fast food consumption has increased dramatically in the general population over the last 25 years. However, little is known about the prevalence and nutritional implications of fast food consumption among patients receiving hemodialysis.

Methods: By using a cross-sectional study design, we obtained data on fast food consumption and nutrient intake (from four separate 24-hour dietary recalls) and nutritional parameters (from chart abstraction) for 194 randomly selected patients from 44 hemodialysis facilities in northeast Ohio.

Job satisfaction among renal dietitians.

Objective: Little is known about job satisfaction among renal dietitians. We sought to determine overall job satisfaction and specific domains of job satisfaction among renal dietitians.

Design: Cross-sectional study.

Improving albumin levels among hemodialysis patients: a community-based randomized controlled trial.

Background: Low albumin level is a strong predictor of mortality and morbidity among hemodialysis patients, yet few interventions are available to improve albumin levels. Moreover, the relative importance of nutritional barriers versus inflammation in contributing to hypoalbuminemia is unclear. We sought to determine whether targeting specific nutritional barriers will improve albumin levels.

Determinants of metabolic acidosis among hemodialysis patients.

Metabolic acidosis is frequently present, poorly controlled, and associated with adverse effects among hemodialysis patients. Potential determinants of metabolic acidosis include endogenous acid production, administration of alkali, neutralization of acid by buffers, dilution of serum bicarbonate by interdialytic fluid gain, and loss of bicarbonate in stool. Understanding the relative importance of these determinants may help guide efforts to manage metabolic acidosis.

The impact of Super Bowl parties on nutritional parameters among hemodialysis patients.

Background: Little is known about the impact of holiday and other special-event meals on patients with chronic medical conditions. It is possible that patients are less adherent with dietary restrictions during such meals. We sought to determine the impact of Super Bowl parties on nutritional parameters among hemodialysis patients.

Why are hemodialysis treatments shortened and skipped? Development of a taxonomy and relationship to patient subgroups.

Shortening and skipping hemodialysis treatments occur commonly and are associated with inadequate dialysis and increased mortality. These behaviors are also frequently equated with patient noncompliance. The prevalence and demographic correlates of shortening and skipping treatments have been studied extensively.

Diet monotony as a correlate of poor nutritional intake among hemodialysis patients.

Objective: Nutritional guidelines recommend eating a variety of foods, yet the renal diet restricts the intake of many foods. Poor appetite, present in 10% to 30% of hemodialysis patients, further narrows the range of foods consumed. We sought to determine the relationship between diet monotony and nutritional intake in patients on chronic hemodialysis.